Provider Demographics
NPI:1699829358
Name:RAINIER SURGICAL, INC.
Entity Type:Organization
Organization Name:RAINIER SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-486-0500
Mailing Address - Street 1:1144 29TH ST NW
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2465
Mailing Address - Country:US
Mailing Address - Phone:253-486-0500
Mailing Address - Fax:
Practice Address - Street 1:1144 29TH ST NW
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2465
Practice Address - Country:US
Practice Address - Phone:253-486-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000080335E00000X
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9042151Medicaid
WARA7846OtherREGENCE
OR240489Medicaid
WA0104731OtherWASH LABOR AND INDUSTRIES
WA9058249Medicaid
WA0638680001Medicare NSC