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General NPI Number Information
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NPI Number | 1780726414
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Entity Type | Organization
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Legal Business Name | OLYMPIA CARDIAC SURGERY, INC., P.S.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 525 LILLY RD NE SUITE 200
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City | OLYMPIA
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State | WA
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Zip | 98506-5101
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Country | US
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Telephone | 360-493-4510
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Fax | 360-493-7759
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Provider Business Mailing Address
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Address Line | 525 LILLY RD NE SUITE 200
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City | OLYMPIA
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State | WA
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Zip | 98506-5101
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Country | US
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Telephone | 360-493-4510
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Fax | 360-493-7759
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONNA DICKINSON
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Credential |
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Telephone | 360-493-4510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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