Provider Demographics
NPI:1083818025
Name:NEUROSURGICAL CENTER INC., P.S.
Entity Type:Organization
Organization Name:NEUROSURGICAL CENTER INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-946-9325
Mailing Address - Street 1:780 SWIFT BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3545
Mailing Address - Country:US
Mailing Address - Phone:509-946-9325
Mailing Address - Fax:509-943-8630
Practice Address - Street 1:780 SWIFT BLVD STE 160
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3545
Practice Address - Country:US
Practice Address - Phone:509-946-9325
Practice Address - Fax:509-943-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009772207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7851009Medicaid