Healthcare Provider Details

I. General information

NPI: 1366689069
Provider Name (Legal Business Name): SURGICAL SPECIALISTS FIELD & NEWBOLD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 S 2ND AVE STE 3
WALLA WALLA WA
99362-4183
US

IV. Provider business mailing address

1017 S 2ND AVE STE 3
WALLA WALLA WA
99362-4183
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-1800
  • Fax: 509-525-7515
Mailing address:
  • Phone: 509-525-1800
  • Fax: 509-525-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: FREDERICK I FIELD
Title or Position: PARTNER
Credential: M.D.
Phone: 509-525-1800