Provider Demographics
NPI:1508087693
Name:PHILIP C. KIERNEY M.D. P.S
Entity Type:Organization
Organization Name:PHILIP C. KIERNEY M.D. P.S
Other - Org Name:AMBULATORY PUYALLUP SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PS
Authorized Official - Phone:253-848-8110
Mailing Address - Street 1:105 27TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1150
Mailing Address - Country:US
Mailing Address - Phone:253-848-8110
Mailing Address - Fax:253-845-3561
Practice Address - Street 1:105 27TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1150
Practice Address - Country:US
Practice Address - Phone:253-848-8110
Practice Address - Fax:253-845-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB37277Medicare PIN