Healthcare Provider Details

I. General information

NPI: 1629016555
Provider Name (Legal Business Name): SURGICAL ASSOCIATES NORTHWEST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34612 6TH AVE S SUITE 100
FEDERAL WAY WA
98003-6704
US

IV. Provider business mailing address

34612 6TH AVE S SUITE 100
FEDERAL WAY WA
98003-6704
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-2594
  • Fax:
Mailing address:
  • Phone: 253-661-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberMD00013065
License Number StateWA

VIII. Authorized Official

Name: PAMELA STANFILL
Title or Position: BILLING MANAGER
Credential:
Phone: 253-661-2594