Provider Demographics
NPI:1184607061
Name:PACIFIC RIM OUTPATIENT SURGERY CENTER, LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:PACIFIC RIM OUTPATIENT SURGERY CENTER, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR/MANAGING EMP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:RICHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-788-7750
Mailing Address - Street 1:3009 SQUALICUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1939
Mailing Address - Country:US
Mailing Address - Phone:360-788-7740
Mailing Address - Fax:360-788-7782
Practice Address - Street 1:3009 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-788-7740
Practice Address - Fax:360-788-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602068145001261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119720Medicaid
WA7119720Medicaid