Provider Demographics
NPI:1801073762
Name:NORTHWEST SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:NORTHWEST SURGICAL SPECIALISTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-254-6161
Mailing Address - Street 1:200 NE MOTHER JOSEPH PLACE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3295
Mailing Address - Country:US
Mailing Address - Phone:360-254-6161
Mailing Address - Fax:360-449-1139
Practice Address - Street 1:200 NE MOTHER JOSEPH PL STE 110
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3293
Practice Address - Country:US
Practice Address - Phone:360-254-6161
Practice Address - Fax:360-449-1139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST SURGICAL SPECIALISTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0405810001Medicare NSC