Provider Demographics
NPI:1538855572
Name:SHOULDER STABILITY ORTHOPEDICS
Entity type:Organization
Organization Name:SHOULDER STABILITY ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-620-0211
Mailing Address - Street 1:505 BROADWAY E STE 516
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5023
Mailing Address - Country:US
Mailing Address - Phone:425-429-7573
Mailing Address - Fax:
Practice Address - Street 1:140 4TH AVE N STE 170
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4940
Practice Address - Country:US
Practice Address - Phone:425-429-7573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty