# MT BAKER SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205196649
- **Authorized official:** DR. MATTHEW R PETERSON MD (OWNER)
- **Authorized official phone:** (360) 752-0518

## Contact information

- **Practice address:** 4029 NORTHWEST AVE, SUITE 301, BELLINGHAM, WA 98226-9077
- **Practice address phone:** (360) 752-0518
- **Mailing address:** 8524 W GAGE BLVD STE A1, BOX 319, KENNEWICK, WA 99336-8241
- **Mailing address phone:** (509) 591-0070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | MD00040970 | WA | Yes |

## Other

- **Enumeration date:** 05/18/2012
- **Last updated:** 05/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7144637 | — | WA |