Provider Demographics
NPI:1932285871
Name:WASHINGTON OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WASHINGTON OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:WASHINGTON OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-791-5374
Mailing Address - Street 1:2299 MOWRY AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-791-5374
Mailing Address - Fax:
Practice Address - Street 1:2299 MOWRY AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-791-5374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000466261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ11799ZMedicare ID - Type Unspecified
CA551027Medicare UPIN