Organization
HARBOR ENDOSCOPY CENTER INC
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
4700 POINT FOSDICK DR NW, 308, GIG HARBOR, WA 98335-1706
(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.FX.60100031
WA
261QE0800X
Endoscopy Clinic/Center
Primary
FX00057739
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193456
LABOR & INDUSTRIES
WA
05
—
7119621
—
WA
Enumeration date
02/28/2006
Last updated
01/14/2011
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