Provider Demographics
NPI:1528599685
Name:SOUTH SOUND VASECTOMY AND MEN'S HEALTH
Entity Type:Organization
Organization Name:SOUTH SOUND VASECTOMY AND MEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:ZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-742-3562
Mailing Address - Street 1:324 W BAY DR NW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4926
Mailing Address - Country:US
Mailing Address - Phone:360-742-3562
Mailing Address - Fax:360-915-7925
Practice Address - Street 1:324 W BAY DR NW
Practice Address - Street 2:SUITE 105
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4926
Practice Address - Country:US
Practice Address - Phone:360-742-3562
Practice Address - Fax:360-915-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60017650208D00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty