MOUNT RAINIER UROLOGY INC PS NPI 1053641183

NPI Information

  • NPI: 1053641183
  • Provider Name: MOUNT RAINIER UROLOGY, INC, PS
  • Classification: Urology - 208800000X
  • Entity Type: Organization
  • CLIA Number: 50D2005947
  • Address: 703 LILLY RD NE
    SUITE 106
    OLYMPIA, WA
    ZIP 98506
  • Phone: (360) 350-0281

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NPI Details

MOUNT RAINIER UROLOGY, INC, PS is an urology in Olympia, WA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. MOUNT RAINIER UROLOGY, INC, PS NPI is 1053641183. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

703 LILLY RD NE
SUITE 106
OLYMPIA, WA
ZIP 98506-191
Phone: (360) 350-0281
Fax: (360) 918-8280

The provider's authorized official is Simon Philip Zadina .
The authorized official title is President & Solo Practitioner and has the following contact phone number (360) 350-0281.

The CLIA number assigned to this NPI record is 50D2005947 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/13/2010 and was last updated on 2/23/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrologyMD 60116602WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G8888955MEDICARE PINWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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