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General NPI Number Information
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NPI Number | 1467482679
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Entity Type | Organization
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Legal Business Name | NORTHWEST SURGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 1710 N 13TH LOOP RD
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City | SHELTON
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State | WA
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Zip | 98584-2166
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Country | US
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Telephone | 360-426-4142
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Fax | 360-427-5772
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Provider Business Mailing Address
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Address Line | 1710 N 13TH LOOP RD
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City | SHELTON
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State | WA
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Zip | 98584-2166
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Country | US
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Telephone | 360-426-4142
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Fax | 360-427-5772
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Authorized Official
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Title or Position | OFFICE/BUSINESS MANAGER
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Name | MS. CHERYL R MAHLBERG
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Credential | M.A.
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Telephone | 360-426-4142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00045973
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License Number State | WA
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