Provider Demographics
NPI:1518522606
Name:PRIME SURGERY CENTER PLLC
Entity Type:Organization
Organization Name:PRIME SURGERY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABEER
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:ALIDLEBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-740-0977
Mailing Address - Street 1:1420 3RD ST SE STE 106
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3730
Mailing Address - Country:US
Mailing Address - Phone:253-740-0977
Mailing Address - Fax:
Practice Address - Street 1:5801 SOUNDVIEW DR
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2095
Practice Address - Country:US
Practice Address - Phone:253-740-0977
Practice Address - Fax:253-466-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1005554Medicaid