Provider Demographics
NPI:1275938102
Name:FOURTH CORNER NEUROSURGICAL ASSOCIATES INC PS
Entity Type:Organization
Organization Name:FOURTH CORNER NEUROSURGICAL ASSOCIATES INC PS
Other - Org Name:CASCADE OUTPATIENT SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-676-0922
Mailing Address - Street 1:710 BIRCHWOOD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1720
Mailing Address - Country:US
Mailing Address - Phone:360-527-0404
Mailing Address - Fax:360-527-0407
Practice Address - Street 1:710 BIRCHWOOD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1720
Practice Address - Country:US
Practice Address - Phone:360-676-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOURTH CORNER NEUROSURGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-04
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical