Provider Demographics
NPI:1083732440
Name:SURGICAL WEIGHT LOSS CLINIC OF EASTERN WASHINGTON PLLC
Entity Type:Organization
Organization Name:SURGICAL WEIGHT LOSS CLINIC OF EASTERN WASHINGTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER &SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-0710
Mailing Address - Street 1:1075 JADWIN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3437
Mailing Address - Country:US
Mailing Address - Phone:509-943-0710
Mailing Address - Fax:
Practice Address - Street 1:1075 JADWIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3437
Practice Address - Country:US
Practice Address - Phone:509-943-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1699717009OtherNPI TERRI DAVARI
WA1942363353OtherNPI FOR SAMUEL ROSS FOX
WA1306919725OtherNPI FOR EARL ROSS FOX
WAA04490Medicare UPIN
WA1306919725OtherNPI FOR EARL ROSS FOX