Provider Demographics
NPI:1558455642
Name:PUGET SOUND OTOLARYNGOLOGY INC PS
Entity Type:Organization
Organization Name:PUGET SOUND OTOLARYNGOLOGY INC PS
Other - Org Name:PUGET SOUND SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-775-6651
Mailing Address - Street 1:21616 76TH AVE W
Mailing Address - Street 2:#112
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7512
Mailing Address - Country:US
Mailing Address - Phone:425-775-6651
Mailing Address - Fax:425-670-6718
Practice Address - Street 1:21616 76TH AVE W
Practice Address - Street 2:#112
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-775-6651
Practice Address - Fax:425-670-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB01184Medicare ID - Type Unspecified