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Organization
OVERLAKE AMBULATORY SURGERY CENTER, LLC
Active
Organization
OVERLAKE AMBULATORY SURGERY CENTER, LLC
Active
Other names
Overlake Surgery Center LLC
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY J TAYLOR (EXECUTIVE DIRECTOR)
(425) 709-7523
Entity
Organization
Contact information
Practice address
1135 116TH AVE NE, 300, BELLEVUE, WA 98004
(425) 709-2500
(425) 709-2323
Mailing address
1135 116TH AVE NE, SUITE 300, BELLEVUE, WA 98004
(425) 709-2500
(425) 709-2323
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0141317
LABOR & INDUSTRIES
—
01
—
362
PREMERA BLUE CROSS
—
05
—
7102890
—
WA
01
—
903004
REGENCE BLUE SHIELD
—
Enumeration date
11/01/2006
Last updated
10/29/2012
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