Healthcare Provider Details

I. General information

NPI: 1144290776
Provider Name (Legal Business Name): WEST TACOMA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST SUITE 110
TACOMA WA
98465-1627
US

IV. Provider business mailing address

1628 S MILDRED ST SUITE 110
TACOMA WA
98465-1613
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-2009
  • Fax: 253-564-7420
Mailing address:
  • Phone: 253-564-2009
  • Fax: 253-564-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSEPH F. JASPER
Title or Position: MEDICAL DIRCT/MANAGING MEMBER
Credential: M.D.
Phone: 253-564-2009