Healthcare Provider Details

I. General information

NPI: 1770564783
Provider Name (Legal Business Name): SURGICAL ASSOCIATES NORTHWEST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 3RD ST NE
AUBURN WA
98002-4035
US

IV. Provider business mailing address

125 3RD ST NE
AUBURN WA
98002-4035
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-4050
  • Fax: 253-735-5083
Mailing address:
  • Phone: 253-833-4050
  • Fax: 253-735-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAM STANFILL
Title or Position: OFFICE MANAGER
Credential:
Phone: 253-833-4050