Provider Demographics
NPI:1477617751
Name:COLUMBIA SURGICAL SPECIALISTS, PS
Entity Type:Organization
Organization Name:COLUMBIA SURGICAL SPECIALISTS, PS
Other - Org Name:COLUMBIA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:J
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-624-2326
Mailing Address - Street 1:PO BOX 2242
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-2242
Mailing Address - Country:US
Mailing Address - Phone:509-624-2326
Mailing Address - Fax:509-789-5702
Practice Address - Street 1:217 W CATALDO
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-624-2326
Practice Address - Fax:509-252-2837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA SURGICAL SPECIALISTS, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAASF.FS.60099962261QA1903X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50C0001176OtherMEDICARE ASC CERTIFICATION
WAG14297Medicare PIN