Provider Demographics
NPI:1619921863
Name:CENTER FOR BONE & JOINT SURGERY LTD
Entity Type:Organization
Organization Name:CENTER FOR BONE & JOINT SURGERY LTD
Other - Org Name:THE CENTER FOR BONE & JOINT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSECRANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-417-0200
Mailing Address - Street 1:832 GEORGIANA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3512
Mailing Address - Country:US
Mailing Address - Phone:360-457-7003
Mailing Address - Fax:360-457-7023
Practice Address - Street 1:832 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3512
Practice Address - Country:US
Practice Address - Phone:360-457-7003
Practice Address - Fax:360-457-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7105786Medicaid
WA134309OtherWORKERS COMP
WACG1904OtherRAILROAD MEDICARE
WA7105786Medicaid