Provider Demographics
NPI:1588608871
Name:SOUTH HILL SURGICAL PRACTICE INC
Entity Type:Organization
Organization Name:SOUTH HILL SURGICAL PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-770-9111
Mailing Address - Street 1:337 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5025
Mailing Address - Country:US
Mailing Address - Phone:253-770-9111
Mailing Address - Fax:
Practice Address - Street 1:337 4TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5025
Practice Address - Country:US
Practice Address - Phone:253-770-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8856370Medicare ID - Type Unspecified