# CAPITOL SURGERY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waverly Lake Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851520514
- **Authorized official:** JENNIFER D KOLB (ADMINISTRATOR)
- **Authorized official phone:** (541) 918-4210

## Contact information

- **Practice address:** 633 WAVERLY DR SE, ALBANY, OR 97322-5078
- **Practice address phone:** (541) 918-4210
- **Practice address fax:** (541) 918-4215
- **Mailing address:** 633 WAVERLY DR SE, ALBANY, OR 97322-5078
- **Mailing address phone:** (541) 918-4210
- **Mailing address fax:** (541) 918-4215

## Taxonomy

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

## Other

- **Enumeration date:** 07/02/2009
- **Last updated:** 12/16/2021