Provider Demographics
NPI:1528027737
Name:HARBOR SURGICAL ASSOCIATES, INC., P.S.
Entity Type:Organization
Organization Name:HARBOR SURGICAL ASSOCIATES, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JURIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:360-537-6414
Mailing Address - Street 1:1006 N H ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2521
Mailing Address - Country:US
Mailing Address - Phone:360-537-6414
Mailing Address - Fax:360-532-6878
Practice Address - Street 1:1006 N H ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2521
Practice Address - Country:US
Practice Address - Phone:360-537-6414
Practice Address - Fax:360-532-6878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR SURGICAL ASSOCIATES INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-17
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00010490208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA022161238OtherMEDICARE RR PROVIDER
WA000800078OtherMEDICARE PROVIDER
WA7077316Medicaid
WA8914472OtherCRIME VICTIMS
WAA0003OtherTRICARE
WA0012648OtherLI PROVIDER NUMBER
WA335846100OtherUS DEPT OF LABOR
WA0154469OtherLI GROUP NUMBER
WA115141600OtherMEDICARE GROUP
WADC4850OtherRR MEDICARE
WA1532605Medicaid
WAMA1607OtherCOUNTY
WADC4850OtherRR MEDICARE
WAE17956Medicare UPIN