1275647422 NPI number — SOUTHWEST WASHINGTON THORACIC AND VASCULAR SURGERY PS

Table of content: (NPI 1275647422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275647422 NPI number — SOUTHWEST WASHINGTON THORACIC AND VASCULAR SURGERY PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST WASHINGTON THORACIC AND VASCULAR SURGERY PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275647422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 SE STONEMILL DR.
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-735-3480
Provider Business Mailing Address Fax Number:
360-735-3481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-514-1854
Provider Business Practice Location Address Fax Number:
360-514-6063
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LITVIN
Authorized Official First Name:
KURT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXEC. DIRECTOR
Authorized Official Telephone Number:
360-735-8100

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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