=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013040500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERGENCY ROOMS, PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 08/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4421 NE ST JOHNS RD SUITE F
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-695-9922
-----------------------------------------------------
Fax | 360-695-1310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4421 NE ST JOHNS RD SUITE F
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-695-9922
-----------------------------------------------------
Fax | 360-695-1310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS
-----------------------------------------------------
Name | MS. LEANN M BIGONI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-695-9922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------