Organization
NORTHWEST AMBULATORY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON S NISHIMOTO DPM (PRESIDENT)
(425) 316-3700
Entity
Organization
Contact information
Practice address
1920 100TH ST SE, A1, EVERETT, WA 98208-3832
(425) 316-3700
(425) 316-6881
Mailing address
1920 100TH ST SE, A1, EVERETT, WA 98208-3832
(425) 316-3700
(425) 316-6881
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
PO 00000725
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105943
WORKERS COMP
WA
05
—
7120629
—
WA
Enumeration date
09/25/2006
Last updated
08/22/2020
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