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General NPI Number Information
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NPI Number | 1750191029
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Entity Type | Organization
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Legal Business Name | GH EDMONDS ENDOSCOPY CENTER SUB LLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 21600 HIGHWAY 99 STE 260
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City | EDMONDS
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State | WA
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Zip | 98026-8049
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Country | US
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Telephone | 469-872-4706
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Fax |
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Provider Business Mailing Address
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Address Line | 21600 HIGHWAY 99 STE 260
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City | EDMONDS
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State | WA
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Zip | 98026-8049
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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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 |
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License Number State |
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