Provider Demographics
NPI:1982853271
Name:WESTERN WASHINGTON ENDOSCOPY CENTERS LLC
Entity Type:Organization
Organization Name:WESTERN WASHINGTON ENDOSCOPY CENTERS LLC
Other - Org Name:SUNRISE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-655-1283
Mailing Address - Street 1:11216 SUNRISE BLVD E
Mailing Address - Street 2:SUITE 201, BLDG 3
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8848
Mailing Address - Country:US
Mailing Address - Phone:253-503-2057
Mailing Address - Fax:253-572-8204
Practice Address - Street 1:11216 SUNRISE BLVD E
Practice Address - Street 2:SUITE 201, BLDG 3
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-503-2057
Practice Address - Fax:253-572-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8880511Medicare PIN