Organization
TACOMA ENDOSCOPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G CARROUGHER MD (MEDICAL DIRECTOR)
(253) 272-8664
Entity
Organization
Contact information
Practice address
1112 6TH AVE, 200, TACOMA, WA 98405-4040
(253) 272-8664
(253) 404-1352
Mailing address
1112 6TH AVE, 200, TACOMA, WA 98405-4040
(253) 272-8664
(253) 404-1352
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
ASF.FS.60099979
WA
261QE0800X
Endoscopy Clinic/Center
Primary
FX00056070
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7065394
—
WA
01
—
77687
LABOR & INDUSTRIES
WA
01
—
TA2834
REGENCE
—
Enumeration date
02/28/2006
Last updated
01/14/2011
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