Provider Demographics
NPI:1780726414
Name:OLYMPIA CARDIAC SURGERY, INC., P.S.
Entity type:Organization
Organization Name:OLYMPIA CARDIAC SURGERY, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-493-4510
Mailing Address - Street 1:525 LILLY RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5101
Mailing Address - Country:US
Mailing Address - Phone:360-493-4510
Mailing Address - Fax:360-493-7759
Practice Address - Street 1:525 LILLY RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5101
Practice Address - Country:US
Practice Address - Phone:360-493-4510
Practice Address - Fax:360-493-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7059553Medicaid
WA115104000Medicare ID - Type Unspecified