Provider Demographics
NPI:1164527933
Name:WHATCOM ASC LLC
Entity type:Organization
Organization Name:WHATCOM ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAO, BOARD MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-838-3767
Mailing Address - Street 1:2075 BARKLEY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6734
Mailing Address - Country:US
Mailing Address - Phone:360-671-6933
Mailing Address - Fax:360-671-0196
Practice Address - Street 1:2075 BARKLEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6734
Practice Address - Country:US
Practice Address - Phone:360-671-6933
Practice Address - Fax:360-671-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
WAASF.FS.60102997261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BN6929030OtherDEA #
BN6929030OtherDEA #