Provider Demographics
NPI:1366536880
Name:SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER, LLC
Entity type:Organization
Organization Name:SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-449-6309
Mailing Address - Street 1:200 NE MOTHER JOSEPH PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3294
Mailing Address - Country:US
Mailing Address - Phone:360-449-6300
Mailing Address - Fax:360-449-6370
Practice Address - Street 1:200 NE MOTHER JOSEPH PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3294
Practice Address - Country:US
Practice Address - Phone:360-449-6300
Practice Address - Fax:360-449-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7107485Medicaid
WAAB23050Medicare ID - Type Unspecified