MEDICARE: VP SURGERY CENTER OF AUBURN LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	603173594	WA

General Provider Information

NPI Number	:	1932530284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VP SURGERY CENTER OF AUBURN LLC

Provider Business Mailing Address
First Line	:	PO BOX 960
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-0960
Country	:	US
Telephone Number	:	360-736-0928
Fax Number	:	360-736-0921

Provider Business Practice Location Address
First Line	:	1002 15TH ST SW STE 215
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98001-6502
Country	:	US
Telephone Number	:	253-736-6600
Fax Number	:	253-736-6601

Authorized Official
Title or Position	:	MANAGER
Name	:	MELODIE WILSON
Credential	:
Telephone Number	:	360-736-0928

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	06/30/2014

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