Healthcare Provider Details

I. General information

NPI: 1467515015
Provider Name (Legal Business Name): SURGERY CENTER OF SILVERDALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 LEVIN RD NW # 102
SILVERDALE WA
98383-7856
US

IV. Provider business mailing address

9800 LEVIN RD NW # 102
SILVERDALE WA
98383-7856
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-2728
  • Fax: 360-692-6009
Mailing address:
  • Phone: 360-692-2728
  • Fax: 360-692-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number602478678
License Number StateWA

VIII. Authorized Official

Name: DR. BLAKE REITER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 360-692-2728