NPIMap

Organization Active NPI

PA Surgical Services

  • Surgical Physician Assistant
  • Kirkland, WA
National Provider Identifier
1871672899
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10000442 Issued in WA
Legal business name
PA SURGICAL SERVICES
Practice address
12303 NE 130TH LN
Suite 520
Kirkland, WA 98034-3099
Phone
(425) 899-5510
Fax
(425) 899-5524
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kent Wallace, PA-CNPI 1770662835
Title
Owner
Phone
(425) 899-5510

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
Surgical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AS0400X PA10000442 WA Primary

Addresses

Primary practice location

12303 NE 130TH LN
Suite 520
Kirkland, WA 98034-3099

Mailing address

PO Box 8592
Kirkland, WA 98034-0592

National Provider Directory

National Provider Directory

Locations

3501 Colby Ave
Ste 201
Everett, WA 98201

Practitioners & affiliated clinicians

Practitioners 8

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": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871672899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8592",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980340592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 NE 130TH LN",
            "address_2": "SUITE 520",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343099",
            "telephone_number": "425-899-5510",
            "fax_number": "425-899-5524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PA SURGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-899-5510",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10000442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.