# THE EASTSIDE ENDOSCOPY CENTER LLC

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

## Provider details

- **NPI number:** 1992702443
- **Authorized official:** NICOLAS GORALSKY (COO)
- **Authorized official phone:** (253) 383-8342

## Contact information

- **Practice address:** 1135 116TH AVE NE, SUITE 570, BELLEVUE, WA 98004-4623
- **Practice address phone:** (425) 451-7335
- **Practice address fax:** (425) 451-1226
- **Mailing address:** 1135 116TH AVE NE, BELLEVUE, WA 98004-4623
- **Mailing address phone:** (425) 544-7684
- **Mailing address fax:** (425) 462-8021

## Taxonomy

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

## Other

- **Enumeration date:** 06/30/2005
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 15949 | AAAHC ACCREDITATION | — |
| 01 | — | 50D0923026 | CLIA NUMBER | WA |
| 05 | — | 7067366 | — | WA |
| 01 | — | EA0308 | REGENCE BS | WA |
| 01 | — | MTS-3102 | STATE LICENSE | WA |