Provider Demographics
NPI:1467515015
Name:SURGERY CENTER OF SILVERDALE LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF SILVERDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-692-2728
Mailing Address - Street 1:9800 LEVIN RD NW # 102
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7856
Mailing Address - Country:US
Mailing Address - Phone:360-692-2728
Mailing Address - Fax:360-692-6009
Practice Address - Street 1:9800 LEVIN RD NW # 102
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7856
Practice Address - Country:US
Practice Address - Phone:360-692-2728
Practice Address - Fax:360-692-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602478678261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7138217Medicaid
P00403366OtherRAILROAD MEDICARE
WA7138217Medicaid