Healthcare Provider Details

I. General information

NPI: 1962453860
Provider Name (Legal Business Name): EMERGENCY MEDICINE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 92ND AVE
VANCOUVER WA
98664-3225
US

IV. Provider business mailing address

PO BOX 742997
LOS ANGELES CA
90074-2997
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2000
  • Fax: 360-514-6820
Mailing address:
  • Phone: 781-280-1773
  • Fax: 781-280-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number601287343
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL M GORECKI
Title or Position: MD/AUTHORIZED OFFICIAL
Credential: MD
Phone: 360-514-2142