Provider Demographics
NPI:1457793390
Name:BARIATRIC SURGERY CLINIC TRUST
Entity Type:Organization
Organization Name:BARIATRIC SURGERY CLINIC TRUST
Other - Org Name:SEATTLE PACIFIC SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-2771
Mailing Address - Street 1:1560 N 115TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8414
Mailing Address - Country:US
Mailing Address - Phone:206-368-1070
Mailing Address - Fax:206-368-4172
Practice Address - Street 1:12728 19TH AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6526
Practice Address - Country:US
Practice Address - Phone:425-225-2700
Practice Address - Fax:425-225-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty