Provider Demographics
NPI:1629016555
Name:SURGICAL ASSOCIATES NORTHWEST, PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES NORTHWEST, PC
Other - Org Name:RAINIER SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-661-2594
Mailing Address - Street 1:34612 6TH AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6704
Mailing Address - Country:US
Mailing Address - Phone:253-661-2594
Mailing Address - Fax:
Practice Address - Street 1:34612 6TH AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6704
Practice Address - Country:US
Practice Address - Phone:253-661-2594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA1903X
WAMD00013065261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7134158Medicaid
WA7134158Medicaid
WAG8857804Medicare PIN