Provider Demographics
NPI:1467578393
Name:OLYMPIC PLASTIC SURGERY SUITE
Entity Type:Organization
Organization Name:OLYMPIC PLASTIC SURGERY SUITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-415-0762
Mailing Address - Street 1:2600 CHERRY AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310
Mailing Address - Country:US
Mailing Address - Phone:360-415-0762
Mailing Address - Fax:360-792-1166
Practice Address - Street 1:2600 CHERRY AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310
Practice Address - Country:US
Practice Address - Phone:360-415-0762
Practice Address - Fax:360-792-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7041791Medicaid
WA55649OtherL & I
WAG8879945Medicare PIN