Healthcare Provider Details

I. General information

NPI: 1295790970
Provider Name (Legal Business Name): SEQUIM SAME DAY SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N 5TH AVE
SEQUIM WA
98382-3080
US

IV. Provider business mailing address

777 N 5TH AVE
SEQUIM WA
98382-3080
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-2632
  • Fax: 360-582-2631
Mailing address:
  • Phone: 360-582-2632
  • Fax: 360-582-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number600 628 919
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOSEPH NOVAK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 360-457-1431