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General NPI Number Information
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NPI Number | 1134498041
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Entity Type | Organization
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Legal Business Name | COLUMBIA UNITED PROVIDERS
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 19120 SE 34TH ST SUITE 201
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City | VANCOUVER
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State | WA
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Zip | 98683-1429
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Country | US
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Telephone | 360-449-8861
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Fax | 360-449-8862
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Provider Business Mailing Address
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Address Line | 19120 SE 34TH ST SUITE 201
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City | VANCOUVER
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State | WA
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Zip | 98683-1429
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Country | US
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Telephone | 360-449-8861
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Fax | 360-449-8862
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. ANN WHEELOCK
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Credential |
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Telephone | 360-449-8938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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