Provider Demographics
NPI:1861820680
Name:LURCH SURGICAL
Entity Type:Organization
Organization Name:LURCH SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-855-7025
Mailing Address - Street 1:2580 LAKE WHATCOM BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2721
Mailing Address - Country:US
Mailing Address - Phone:360-855-7025
Mailing Address - Fax:360-588-6928
Practice Address - Street 1:2580 LAKE WHATCOM BLVD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2721
Practice Address - Country:US
Practice Address - Phone:360-855-7025
Practice Address - Fax:360-588-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045866282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8453367Medicaid
WA8453367Medicaid