Basic Information
| Provider Information | |||||||||
| NPI: | 1699950253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR MINIMALLY INVASIVE SURGERY PLLC | ||||||||
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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: | 1802 YAKIMA AVE | ||||||||
| Address2: | 202 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535727120 | ||||||||
| FaxNumber: | 2535721071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | BEAN | ||||||||
| AuthorizedOfficialFirstName: | PATI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2535727120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.