Healthcare Provider Details

I. General information

NPI: 1306321237
Provider Name (Legal Business Name): RAINIER SPRINGS PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 NE 129TH STREET
VANCOUVER WA
98686
US

IV. Provider business mailing address

101 S 5TH ST
LOUISVILLE KY
40202-3157
US

V. Phone/Fax

Practice location:
  • Phone: 360-356-1890
  • Fax: 360-356-1891
Mailing address:
  • Phone: 360-356-1890
  • Fax: 360-356-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG MILLER
Title or Position: EVP, CFO
Credential:
Phone: 412-588-3546