Healthcare Provider Details

I. General information

NPI: 1679858849
Provider Name (Legal Business Name): THE EASTSIDE ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 4TH AVE NW STE 301
ISSAQUAH WA
98027-9369
US

IV. Provider business mailing address

1301 4TH AVE NW STE 301
ISSAQUAH WA
98027-9371
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4768
  • Fax:
Mailing address:
  • Phone: 253-503-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GORALSKY
Title or Position: COO
Credential:
Phone: 253-272-8177