Provider Demographics
NPI:1205012887
Name:ALDERWOOD SURGERY CENTER LLC
Entity type:Organization
Organization Name:ALDERWOOD SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GRICELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-209-0988
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:SUITE 320
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-324-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50C0001054Medicare PIN