NPIMap

Organization Active NPI

South Sound Ambulatory Surgery Center, PLLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Olympia, WA
National Provider Identifier
1487183000
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
601803289 Issued in WA
Legal business name
SOUTH SOUND AMBULATORY SURGERY CENTER, PLLC
Practice address
3425 Ensign Rd NE Ste 310
Olympia, WA 98506-5063
Phone
(360) 456-5678
Fax
(360) 456-1238
NPI assigned
Jun 7, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH SOUND ORAL SURGERY PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Joseph C Mulrean, DMDNPI 1336250133
Title
Co-Owner
Phone
(360) 456-5678

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X 601803289 WA Primary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X

Addresses

Primary practice location

3425 Ensign Rd NE Ste 310
Olympia, WA 98506-5063

Mailing address

3425 Ensign Rd NE Ste 310
Olympia, WA 98506-5063
Phone (360) 456-5678

National Provider Directory

National Provider Directory
Part of
South Sound Oral Surgery PLLC

Locations

3425 Ensign Rd NE
Ste 310
Olympia, WA 98506
Phone (360) 456-5678

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1487183000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 ENSIGN RD NE STE 310",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065063",
            "telephone_number": "360-456-5678",
            "fax_number": "360-456-1238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 ENSIGN RD NE STE 310",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065063",
            "telephone_number": "360-456-5678",
            "fax_number": "360-456-1238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SOUND AMBULATORY SURGERY CENTER, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH SOUND ORAL SURGERY PLLC",
        "enumeration_date": "2017-06-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MULREAN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "360-456-5678",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WA",
            "license": "601803289",
            "primary": true
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.