Provider Demographics
NPI:1396833919
Name:CABRINI TOWER AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:CABRINI TOWER AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HAECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-464-0873
Mailing Address - Street 1:901 BOREN AVE STE 1650
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3508
Mailing Address - Country:US
Mailing Address - Phone:206-464-0873
Mailing Address - Fax:206-467-7351
Practice Address - Street 1:901 BOREN AVE STE 1650
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3508
Practice Address - Country:US
Practice Address - Phone:206-464-0873
Practice Address - Fax:206-467-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6023535960010001261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6023535960010001OtherUBI NO.