Provider Demographics
NPI:1770564783
Name:SURGICAL ASSOCIATES NORTHWEST, P.C.
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES NORTHWEST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-833-4050
Mailing Address - Street 1:125 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4035
Mailing Address - Country:US
Mailing Address - Phone:253-833-4050
Mailing Address - Fax:253-735-5083
Practice Address - Street 1:125 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4035
Practice Address - Country:US
Practice Address - Phone:253-833-4050
Practice Address - Fax:253-735-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1336205Medicaid
WA1107119Medicaid
WA1051069Medicaid
WA1056662Medicaid
WA1056662Medicaid
WA1051069Medicaid
WAA08750Medicare UPIN
WA1336205Medicaid
WA1107119Medicaid