Organization
LOWER COLUMBIA AMBULATORY SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER IEROKOMOS MD (OWNER)
(360) 423-0960
Entity
Organization
Contact information
Practice address
820 11TH AVE, LONGVIEW, WA 98632-2402
(360) 423-0960
(360) 423-8778
Mailing address
820 11TH AVE, LONGVIEW, WA 98632-2402
(360) 423-0960
(360) 423-8778
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147562
L&I
WA
05
—
7134463
—
WA
Enumeration date
06/08/2006
Last updated
02/29/2008
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