Provider Demographics
NPI:1164662474
Name:OLYMPIC PLASTIC SURGERY CENTER LLC
Entity type:Organization
Organization Name:OLYMPIC PLASTIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-286-2456
Mailing Address - Street 1:9927 MICKELBERRY RD NW STE 121
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7861
Mailing Address - Country:US
Mailing Address - Phone:360-286-2456
Mailing Address - Fax:855-653-6340
Practice Address - Street 1:9927 MICKELBERRY RD NW STE 121
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7861
Practice Address - Country:US
Practice Address - Phone:360-286-2456
Practice Address - Fax:855-653-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002281208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty