=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386615912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUGET SOUND GASTROENTEROLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2006
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 N 34TH ST SUITE 101
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-8645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-838-1777
-----------------------------------------------------
Fax | 206-838-1771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34888
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98124-1888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-977-4620
-----------------------------------------------------
Fax | 425-745-9836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ALAN OLIVER
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 786-530-3820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 600388519
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------