Healthcare Provider Details

I. General information

NPI: 1134290182
Provider Name (Legal Business Name): PORT TOWNSEND SURGICAL ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SHERIDAN STREET SUITE 201
PORT TOWNSEND WA
98368
US

IV. Provider business mailing address

1010 SHERIDAN STREET SUITE 201
PORT TOWNSEND WA
98368
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-5444
  • Fax: 360-385-5352
Mailing address:
  • Phone: 360-385-5444
  • Fax: 360-385-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY A LAWRENCE
Title or Position: PRESIDENT
Credential: DO FACOS
Phone: 360-385-5444