Provider Demographics
NPI:1528127362
Name:ISLAND SURGEONS PS INC
Entity type:Organization
Organization Name:ISLAND SURGEONS PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-293-5142
Mailing Address - Street 1:1213 24TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2592
Mailing Address - Country:US
Mailing Address - Phone:360-293-5142
Mailing Address - Fax:390-299-2043
Practice Address - Street 1:1213 24TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2592
Practice Address - Country:US
Practice Address - Phone:360-293-5142
Practice Address - Fax:390-299-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAW103051OtherTRICARE
WA33480OtherLABOR AND INDUSTRIES
WA064973001OtherGROUP HEALTH
WA7743206Medicaid
WA001145700Medicare PIN