# PUYALLUP AMBULATORY SURGERY CENTER, LLC

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

## Provider details

- **NPI number:** 1700661212
- **Authorized official:** WILLIAM GLENN ROBERTSON (CEO)
- **Authorized official phone:** (253) 403-1272

## Contact information

- **Practice address:** 1519 3RD ST SE \#240, PUYALLUP, WA 98372
- **Practice address phone:** (253) 845-0757
- **Practice address fax:** (253) 845-0866
- **Mailing address:** P.O. BOX 5299, MS: 820-5-PCO, TACOMA, WA 98415-0299

## Taxonomy

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

## Other

- **Enumeration date:** 08/31/2023
- **Last updated:** 08/04/2025