Healthcare Provider Details

I. General information

NPI: 1134218167
Provider Name (Legal Business Name): WASHINGTON ORTHOPAEDIC CENTER, INC, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOKS HILL RD
CENTRALIA WA
98531
US

IV. Provider business mailing address

1900 COOKS HILL RD
CENTRALIA WA
98531
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2889
  • Fax: 360-736-9777
Mailing address:
  • Phone: 360-736-2889
  • Fax: 360-736-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number600111876
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KURT KENTFIELD
Title or Position: ADMINISTRATOR
Credential:
Phone: 360-736-2889