Provider Demographics
NPI:1871512756
Name:EASTSIDE UROLOGY ASSOCIATES,. P.S.
Entity Type:Organization
Organization Name:EASTSIDE UROLOGY ASSOCIATES,. P.S.
Other - Org Name:EASTSIDE UROLOGY ASSOCIATES ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-5801
Mailing Address - Street 1:11911 NE 132ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2900
Mailing Address - Country:US
Mailing Address - Phone:425-899-5800
Mailing Address - Fax:425-899-5806
Practice Address - Street 1:11911 NE 132ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2900
Practice Address - Country:US
Practice Address - Phone:425-899-5800
Practice Address - Fax:425-899-5806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTSIDE UROLOGY ASSOCIATES PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-19
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical