Provider Demographics
NPI:1982745568
Name:NORTHWEST SURGERY CENTER, INC
Entity Type:Organization
Organization Name:NORTHWEST SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWANSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-483-9363
Mailing Address - Street 1:123 W FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6348
Mailing Address - Country:US
Mailing Address - Phone:509-483-9363
Mailing Address - Fax:509-483-0355
Practice Address - Street 1:123 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6348
Practice Address - Country:US
Practice Address - Phone:509-483-9363
Practice Address - Fax:509-483-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601074808261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601074808OtherSTATE LICENSE NUMBER
WA7022817Medicaid
WA490002922OtherRAILROAD MEDICARE
WA03566OtherLABOR AND INDUSTRIES
WA490002922OtherRAILROAD MEDICARE