Provider Demographics
NPI:1154459550
Name:SOUTHWEST WASHINGTON ANESTHESIA PS
Entity Type:Organization
Organization Name:SOUTHWEST WASHINGTON ANESTHESIA PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-943-8470
Mailing Address - Street 1:1825 FOREST HILL DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3736
Mailing Address - Country:US
Mailing Address - Phone:360-943-8470
Mailing Address - Fax:
Practice Address - Street 1:1900 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9073
Practice Address - Country:US
Practice Address - Phone:360-943-8470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA207L00000XMedicaid
WAG000986400Medicare PIN
WAE32957Medicare UPIN