Organization
MT BAKER SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW R PETERSON MD (OWNER)
(360) 752-0518
Entity
Organization
Contact information
Practice address
4029 NORTHWEST AVE, SUITE 301, BELLINGHAM, WA 98226-9077
(360) 752-0518
Mailing address
8524 W GAGE BLVD STE A1, BOX 319, KENNEWICK, WA 99336-8241
(509) 591-0070
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
MD00040970
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7144637
—
WA
Enumeration date
05/18/2012
Last updated
05/18/2012
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