Healthcare Provider Details

I. General information

NPI: 1821289653
Provider Name (Legal Business Name): VANCOUVER EAR, NOSE & THROAT HEAD & NECK SURGERY CLINIC, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 NE 20TH AVE SUITE 101
VANCOUVER WA
98686-6431
US

IV. Provider business mailing address

1405 SE 164TH AVE SUITE 102
VANCOUVER WA
98683-9644
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-4425
  • Fax: 360-260-7249
Mailing address:
  • Phone: 360-256-4425
  • Fax: 360-260-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: MR. NATHAN J GEIGLE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 360-449-6612