Healthcare Provider Details

I. General information

NPI: 1194963249
Provider Name (Legal Business Name): NW GERIATRIC CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S ANDRESEN RD
VANCOUVER WA
98661-7603
US

IV. Provider business mailing address

11500 NE 76TH ST STE A3 PMB 7
VANCOUVER WA
98662-3901
US

V. Phone/Fax

Practice location:
  • Phone: 360-693-7877
  • Fax: 360-750-6900
Mailing address:
  • Phone: 360-254-3663
  • Fax: 360-254-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00019932
License Number StateWA

VIII. Authorized Official

Name: DR. TIMOTHY T ROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 360-693-7877