Healthcare Provider Details

I. General information

NPI: 1013040500
Provider Name (Legal Business Name): EMERGENCY ROOMS, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 NE ST JOHNS RD SUITE F
VANCOUVER WA
98661-2573
US

IV. Provider business mailing address

4421 NE ST JOHNS RD SUITE F
VANCOUVER WA
98661-2573
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-9922
  • Fax: 360-695-1310
Mailing address:
  • Phone: 360-695-9922
  • Fax: 360-695-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LEANN M BIGONI
Title or Position: OPERATIONS
Credential:
Phone: 360-695-9922