Healthcare Provider Details

I. General information

NPI: 1588186274
Provider Name (Legal Business Name): SILOAM PARTNERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16821 SE MCGILLIVRAY BLVD STE 204
VANCOUVER WA
98683-0402
US

IV. Provider business mailing address

16821 SE MCGILLIVRAY BLVD STE 204
VANCOUVER WA
98683-0402
US

V. Phone/Fax

Practice location:
  • Phone: 360-433-9580
  • Fax: 866-824-5107
Mailing address:
  • Phone: 360-433-9580
  • Fax: 866-824-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE RENEE JONES
Title or Position: PRESIDENT
Credential: ARNP
Phone: 360-624-0152