Provider Demographics
NPI:1841286101
Name:GOOD SAMARITAN SURGERY CENTER LLC
Entity type:Organization
Organization Name:GOOD SAMARITAN SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-697-2074
Mailing Address - Street 1:1322 3RD ST SE
Mailing Address - Street 2:100
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3771
Mailing Address - Country:US
Mailing Address - Phone:253-697-5700
Mailing Address - Fax:253-840-2352
Practice Address - Street 1:1322 3RD ST SE
Practice Address - Street 2:100
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3771
Practice Address - Country:US
Practice Address - Phone:253-697-5700
Practice Address - Fax:253-840-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7030638Medicaid