1891785903 NPI number — SOUTHWEST WASHINGTON MEDICAL CENTER

Table of content: (NPI 1891785903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891785903 NPI number — SOUTHWEST WASHINGTON MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST WASHINGTON MEDICAL CENTER
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:
1891785903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1600
Provider Second Line Business Mailing Address:
PHARMACY DEPARTMENT
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98668-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-514-2294
Provider Business Mailing Address Fax Number:
360-514-2003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 NE MOTHER JOSEPH PL
Provider Second Line Business Practice Location Address:
PHARMACY DEPARTMENT
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-514-2294
Provider Business Practice Location Address Fax Number:
360-514-2003
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROSS
Authorized Official First Name:
RICK
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHARMACY OPERATIONS MANAGER
Authorized Official Telephone Number:
360-514-6087

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000070 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4923315 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4923315 . This is a "NABP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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