Provider Demographics
NPI:1699950253
Name:CENTER FOR MINIMALLY INVASIVE SURGERY PLLC
Entity type:Organization
Organization Name:CENTER FOR MINIMALLY INVASIVE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-572-7120
Mailing Address - Street 1:1802 YAKIMA AVE
Mailing Address - Street 2:202
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-572-7120
Mailing Address - Fax:253-572-1071
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-572-7120
Practice Address - Fax:253-572-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF05209Medicare UPIN