Kitsap Colorectal Surgery Inc PS

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35113 Issued in WA

Legal business name

KITSAP COLORECTAL SURGERY INC PS

Practice address

2528 Wheaton Way
Suite 103
Bremerton, WA 98310-3305

Phone

(360) 377-4717

Fax

(360) 377-4134

NPI assigned

Oct 23, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Johnny B Green, MD

Title

President

Phone

(360) 377-4717

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256256000000",
    "number": "1245566348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 WHEATON WAY",
            "address_2": "SUITE 103",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103305",
            "telephone_number": "360-377-4717",
            "fax_number": "360-377-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 WHEATON WAY",
            "address_2": "SUITE 103",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103305",
            "telephone_number": "360-377-4717",
            "fax_number": "360-377-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITSAP COLORECTAL SURGERY INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-377-4717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "WA",
            "license": "35113",
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "WA",
            "license": "35113",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1109032",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kitsap Audiology & Hearing Aid Clinic, PLLC
• Kitsap Brain Injury
• Kitsap Cardiology Consultants, P.L.L.C.
• Kitsap Chest Consultants PLLC
• Kitsap Clinic of Natural Medicine Inc
• Kitsap Community Resources
• Kitsap County
• Kitsap County Drug Court Alumni Association
• Kitsap Eye Physicians PS
• Kitsap Eye Physicians PS

• Surgery Physician in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.