Healthcare Provider Details

I. General information

NPI: 1437965910
Provider Name (Legal Business Name): RV SURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 S MERIDIAN STE 300
PUYALLUP WA
98373-1283
US

IV. Provider business mailing address

2910 S MERIDIAN STE 300
PUYALLUP WA
98373-1283
US

V. Phone/Fax

Practice location:
  • Phone: 253-650-0908
  • Fax:
Mailing address:
  • Phone: 253-650-0908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAY RUDD
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 253-650-0908