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General NPI Number Information
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NPI Number | 1265527162
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Entity Type | Organization
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Legal Business Name | VANCOUVER ENT AND ENT OF THE NORTHWEST PLLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 1405 SE 164TH AVE STE 102
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City | VANCOUVER
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State | WA
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Zip | 98683-9644
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Country | US
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Telephone | 360-256-4425
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Fax | 360-260-7249
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Provider Business Mailing Address
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Address Line | 1405 SE 164TH AVE STE 102
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City | VANCOUVER
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State | WA
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Zip | 98683-9644
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Country | US
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Telephone | 360-256-4425
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Fax | 360-260-7249
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. NATHAN J GEIGLE
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Credential |
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Telephone | 360-449-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | WA
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