NPIMap

Organization Active NPI

Ear Nose and Throat Associates Southwest Inc PS

  • Ambulatory Surgical Clinic/Center
  • Olympia, WA
National Provider Identifier
1487669305
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS
Practice address
128 Lilly Rd NE Ste 101
Olympia, WA 98506-7400
Phone
(360) 634-4070
Fax
(360) 634-4071
NPI assigned
Jul 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Authorized official

Name
Dr. Sung-Won Kim, M.D.NPI 1558577627
Title
Owner/Partner
Phone
(360) 357-6314

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

128 Lilly Rd NE Ste 101
Olympia, WA 98506-7400

Mailing address

128 Lilly Rd NE Ste 202
Olympia, WA 98506-5029
Phone (360) 357-6314

Other names 1

  • OLYMPIA SURGERY CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031226000116 WA Part B Supplier - Clinic/Group Practice 5294633400 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Olympia, WA
O20231031000589 WA Part B Supplier - Ambulatory Surgical Center 5294633400 Practice locations: Olympia, WA

Ambulatory surgical center certification: CCN 50C0001349

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Olympia Surgery Center
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Aug 5, 2024
Last certification
Jun 25, 2024
Ownership / control type
Proprietary
Facility address
128 Lilly Rd NE Ste 101
Olympia, WA 98506

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2295389Olympia Surgery Center128 Lilly Rd NE Ste 101, Olympia, WA 98506Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

128 Lilly Rd NE
Ste 202
Olympia, WA 98506
Phone (360) 357-6314

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1487669305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LILLY RD NE STE 202",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065029",
            "telephone_number": "360-357-6314",
            "fax_number": "360-705-3745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 LILLY RD NE STE 101",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985067400",
            "telephone_number": "360-634-4070",
            "fax_number": "360-634-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SUNG-WON",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "360-357-6314",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OLYMPIA SURGERY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.