Healthcare Provider Details

I. General information

NPI: 1154459550
Provider Name (Legal Business Name): SOUTHWEST WASHINGTON ANESTHESIA PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

IV. Provider business mailing address

1825 FOREST HILL DR SE
OLYMPIA WA
98501-3736
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-8470
  • Fax:
Mailing address:
  • Phone: 360-943-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00027037
License Number StateWA

VIII. Authorized Official

Name: DR. NOEL BECKFORD
Title or Position: SECRETARY TREASURER
Credential: M.D.
Phone: 360-943-8470