Provider Demographics
NPI:1902868797
Name:SW SEATTLE AMBULATORY SURGERY, LLC
Entity Type:Organization
Organization Name:SW SEATTLE AMBULATORY SURGERY, LLC
Other - Org Name:SOUTHWEST SEATTLE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-243-1100
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0960
Mailing Address - Country:US
Mailing Address - Phone:360-736-0928
Mailing Address - Fax:360-736-0921
Practice Address - Street 1:275 SW 160TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3003
Practice Address - Country:US
Practice Address - Phone:206-988-0927
Practice Address - Fax:206-988-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0184811OtherDEPT OF L&I
WA8930918OtherCRIME VICTIMS L&I
WA7123623Medicaid
WA9788SOOtherREGENCE
WA8803393Medicare ID - Type UnspecifiedMEDICARE