Basic Information
| Provider Information | |||||||||
| NPI: | 1225377278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR MINIMALLY INVASIVE SURGERY PLLC | ||||||||
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| OtherOrganizationName: | SOUNDVIEW AMBULATORY SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 YAKIMA AVE | ||||||||
| Address2: | 202 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535727120 | ||||||||
| FaxNumber: | 2535721071 | ||||||||
| Practice Location | |||||||||
| Address1: | 5801 SOUNDVIEW DR | ||||||||
| Address2: | 156 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983352095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535727120 | ||||||||
| FaxNumber: | 2535721071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2013 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | RIFENBERY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2535727120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.