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General NPI Number Information
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NPI Number | 1841286101
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN SURGERY CENTER LLC
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1322 3RD ST SE 100
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City | PUYALLUP
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State | WA
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Zip | 98372-3771
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Country | US
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Telephone | 253-697-5700
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Fax | 253-840-2352
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Provider Business Mailing Address
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Address Line | 1322 3RD ST SE 100
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City | PUYALLUP
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State | WA
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Zip | 98372-3771
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Country | US
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Telephone | 253-697-5700
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Fax | 253-840-2352
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GLENN KASMAN
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Credential |
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Telephone | 253-697-2074
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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 | WA
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