Provider Demographics
NPI:1790768547
Name:SOUTH SOUND PULMONARY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH SOUND PULMONARY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-413-8257
Mailing Address - Street 1:500 LILLY RD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5197
Mailing Address - Country:US
Mailing Address - Phone:360-413-8272
Mailing Address - Fax:360-413-8878
Practice Address - Street 1:500 LILLY RD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5197
Practice Address - Country:US
Practice Address - Phone:360-413-8272
Practice Address - Fax:360-413-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF94477Medicare UPIN
WAA08289Medicare UPIN
WAA08342Medicare UPIN
WAA55209Medicare UPIN
WAA08710Medicare UPIN