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General NPI Number Information
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NPI Number | 1932530284
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Entity Type | Organization
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Legal Business Name | VP SURGERY CENTER OF AUBURN LLC
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 1002 15TH ST SW STE 215
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City | AUBURN
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State | WA
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Zip | 98001-6502
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Country | US
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Telephone | 253-736-6600
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Fax | 253-736-6601
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Provider Business Mailing Address
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Address Line | PO BOX 960
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City | CENTRALIA
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State | WA
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Zip | 98531-0960
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Country | US
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Telephone | 360-736-0928
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Fax | 360-736-0921
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Authorized Official
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Title or Position | MANAGER
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Name | MELODIE WILSON
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Credential |
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Telephone | 360-736-0928
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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 | 603173594
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License Number State | WA
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