Longview Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

602313328 Issued in WA

Legal business name

LONGVIEW SURGICAL CENTER LLC

Doing business as

Pacific Surgical Center

Practice address

625 9TH Ave
Suite #110
Longview, WA 98632

Phone

(360) 442-7900

Fax

(360) 442-7901

NPI assigned

Sep 22, 2006

Last updated

Sep 12, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer L Myers

Title

Director of Client Services

Phone

(360) 442-7913

Specialties & licenses 1

Addresses

Other names 1

• Pacific Surgical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

Listed as

Longview Surgical Center LLCCCN 50C0001262

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Bruce Gragg Blackstone, M.D.

  • Orthopaedic Surgery Physician
  • Longview, WA
  • NPI 1891760211
  NPD (past)
• Jesse I Broome, CRNA

  • Certified Registered Nurse Anesthetist
  • Longview, WA
  • NPI 1528308558
  NPD (past)
• Susan Lynn Chesley, CRNA

  • Certified Registered Nurse Anesthetist
  • Longview, WA
  • NPI 1417987975
  NPD (past)
• Jon Edward Kretzler, M.D.

  • Orthopaedic Surgery Physician
  • Longview, WA
  • NPI 1417922840
  NPD (past)
• Matthew D Lail, CRNA

  • Certified Registered Nurse Anesthetist
  • Vancouver, WA
  • NPI 1386058386
  NPD (past)
• Shane B Merrill, CRNA

  • Certified Registered Nurse Anesthetist
  • Longview, WA
  • NPI 1487959508
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568246400000",
    "number": "1750481453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 9TH AVE STE 110",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322465",
            "telephone_number": "360-442-7913",
            "fax_number": "360-442-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 9TH AVE",
            "address_2": "SUITE #110",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-442-7900",
            "fax_number": "360-442-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGVIEW SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2019-09-12",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF CLIENT SERVICES",
        "authorized_official_telephone_number": "360-442-7913",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "602313328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Longview Foot & Ankle Clinic
• Longview Housing Authority (Housing Opportunities of SW WA)
• Longview Orthopedic Associates, PLLC
• Longview Physical and Sports Therapy Services PS
• Longview School District
• Longview Surgical Group (Salmon Creek Surgical Specialists)
• Longview Urology PLLC
• Longview VA Clinic
• Sergio Lopez, R-AAC, CPSST
• Catherine Lord

• Ambulatory Surgical Clinic/Center in Longview, WA
• Providers in Longview, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.