Provider Demographics
NPI:1386843746
Name:BELLEVUE SURGERY ASSOC PC
Entity Type:Organization
Organization Name:BELLEVUE SURGERY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELGHAZZAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-688-1916
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:425-688-1916
Mailing Address - Fax:425-688-1901
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 550
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-688-1916
Practice Address - Fax:425-688-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039270208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8274573Medicaid
WA0146095OtherDEPT OF L&I
WA6942ELOtherREGENCE BLUE SHIELD
WA6942ELOtherREGENCE BLUE SHIELD
WA8274573Medicaid