Provider Demographics
NPI:1467011122
Name:WASHINGTON GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:WASHINGTON GASTROENTEROLOGY PLLC
Other - Org Name:WASHINGTON GASTROENTEROLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GORALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-383-8342
Mailing Address - Street 1:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-3006
Mailing Address - Country:US
Mailing Address - Phone:800-734-6855
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:33915 1ST WAY S STE 203
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6396
Practice Address - Country:US
Practice Address - Phone:253-838-9839
Practice Address - Fax:253-661-9077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON GASTROENTEROLOGY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory