Basic Information
| Provider Information | |||||||||
| NPI: | 1912002528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL CENTER ANESTHESIOLOGISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94181 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981246481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253533788 | ||||||||
| FaxNumber: | 4253538041 | ||||||||
| Practice Location | |||||||||
| Address1: | 12333 NE 130TH LN | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253533788 | ||||||||
| FaxNumber: | 4253538041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 11/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | ABRAMS | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4253533788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 7290406 | 05 | WA | MEDICAID | 0018822 | 01 | WA | L & I | OTHER |