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Organization

OVERLAKE AMBULATORY SURGERY CENTER, LLC

Active
Other names
Overlake Surgery Center LLC
Organization subpart
No

Provider details

NPI number
Authorized official
WENDY J TAYLOR (EXECUTIVE DIRECTOR)
(425) 709-7523
Entity
Organization

Contact information

Practice address
1135 116TH AVE NE, 300, BELLEVUE, WA 98004
(425) 709-2500
(425) 709-2323
Mailing address
1135 116TH AVE NE, SUITE 300, BELLEVUE, WA 98004
(425) 709-2500
(425) 709-2323

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0141317
LABOR & INDUSTRIES
01
362
PREMERA BLUE CROSS
05
7102890
WA
01
903004
REGENCE BLUE SHIELD
Enumeration date
11/01/2006
Last updated
10/29/2012
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