MEDICARE: LURCH SURGICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	MD00045866	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861820680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LURCH SURGICAL

Provider Business Mailing Address
First Line	:	2580 LAKE WHATCOM BLVD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-2721
Country	:	US
Telephone Number	:	360-855-7025
Fax Number	:	360-588-6928

Provider Business Practice Location Address
First Line	:	2580 LAKE WHATCOM BLVD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-2721
Country	:	US
Telephone Number	:	360-855-7025
Fax Number	:	360-588-6928

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. JAMES MILLER
Credential	:	MD
Telephone Number	:	360-855-7025

Provider Enumeration Date	:	10/15/2013
Last Update Date	:	10/15/2013

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Directions to “LURCH SURGICAL ” Practice Location

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