Provider Demographics
NPI:1316040405
Name:SURGERY CENTER OF OLYMPIA LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF OLYMPIA LLC
Other - Org Name:SOUTH SOUND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-486-6303
Mailing Address - Street 1:3430 PACIFIC AVE SE
Mailing Address - Street 2:A6 PMB 411
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2176
Mailing Address - Country:US
Mailing Address - Phone:360-486-6300
Mailing Address - Fax:360-493-4242
Practice Address - Street 1:410 PROVIDENCE LN NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6927
Practice Address - Country:US
Practice Address - Phone:360-486-6300
Practice Address - Fax:360-493-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8856793Medicare UPIN