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General NPI Number Information
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NPI Number | 1962402503
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Entity Type | Organization
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Legal Business Name | NORTH KITSAP AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 20669 BOND RD NE SUITE 200
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City | POULSBO
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State | WA
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Zip | 98370-6525
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Country | US
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Telephone | 360-779-6527
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Fax | 360-697-2743
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Provider Business Mailing Address
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Address Line | 20669 BOND RD NE SUITE 200
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City | POULSBO
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State | WA
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Zip | 98370-6525
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Country | US
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Telephone | 360-779-6527
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Fax | 360-697-2743
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | JAMIE FOWLER
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Credential |
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Telephone | 360-779-6527
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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 | 600558138
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License Number State | WA
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