Provider Demographics
NPI:1265574164
Name:SOUND UROLOGICAL ASSOCIATES P.S.
Entity type:Organization
Organization Name:SOUND UROLOGICAL ASSOCIATES P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAMTAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-775-7166
Mailing Address - Street 1:21822 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7900
Mailing Address - Country:US
Mailing Address - Phone:425-775-7166
Mailing Address - Fax:425-672-8844
Practice Address - Street 1:21822 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7900
Practice Address - Country:US
Practice Address - Phone:425-775-7166
Practice Address - Fax:425-672-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABL005871208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACS9060OtherRAILROAD MEDICARE
WACS9060OtherRAILROAD MEDICARE