NPIMap

Organization Active NPI

Walla Walla Clinic, Inc.

Doing business as Walla Walla Clinic Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Walla Walla, WA
National Provider Identifier
1760568273
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
FX00058422 Issued in WA
Legal business name
WALLA WALLA CLINIC, INC.
Doing business as
Walla Walla Clinic Ambulatory Surgery Center
Practice address
55 W Tietan St
Walla Walla, WA 99362-4445
Phone
(509) 525-3720
Fax
(509) 522-1593
NPI assigned
Oct 27, 2006
Last updated
Jul 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

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

Authorized official

Name
Kevin J Michelson
Title
Ceo
Phone
(509) 525-3720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X FX00058422 WA Primary

Addresses

Primary practice location

55 W Tietan St
Walla Walla, WA 99362-4445

Mailing address

55 W Tietan St
Walla Walla, WA 99362-4445
Phone (509) 525-3720

Other names 1

  • Walla Walla Clinic Ambulatory Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040309000142 WA Part B Supplier - Ambulatory Surgical Center 2264320837 Practice locations: Walla Walla, WA

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Walla Walla Clinic IncCCN 50C0001172
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Walla Walla Clinic Surg7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 73

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.

View all 73

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1760568273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720",
            "fax_number": "509-522-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720",
            "fax_number": "509-522-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLA WALLA CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2014-07-23",
        "status": "A",
        "authorized_official_last_name": "MICHELSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-525-3720"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "FX00058422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walla Walla Clinic Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; 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.