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General NPI Number Information
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NPI Number | 1578970117
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Entity Type | Organization
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Legal Business Name | NORTHWEST SURGICAL DEVELOPMENT OF BELLEVUE LLC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 636 120TH AVE NE STE 202
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City | BELLEVUE
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State | WA
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Zip | 98005-3028
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Country | US
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Telephone | 425-454-2410
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Fax | 425-454-2259
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Provider Business Mailing Address
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Address Line | 65 ENTERPRISE STE 125
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2706
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Country | US
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Telephone | 949-600-9931
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Fax | 949-600-8029
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES HAEFNER
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Credential |
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Telephone | 949-600-9931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASF.FS.60329939
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License Number State | WA
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