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General NPI Number Information
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NPI Number | 1780751818
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Entity Type | Organization
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Legal Business Name | PARK PLACE MEDICAL CENTER
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 13115 NE 4TH ST SUITE 230
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City | VANCOUVER
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State | WA
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Zip | 98684-5957
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Country | US
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Telephone | 360-828-8008
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Fax | 360-326-1609
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Provider Business Mailing Address
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Address Line | 13115 NE 4TH ST SUITE 230
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City | VANCOUVER
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State | WA
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Zip | 98684-5957
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Country | US
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Telephone | 360-828-8008
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Fax | 360-326-1609
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER JAMES BESSAS
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Credential | M.D.
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Telephone | 360-828-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD00041827
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License Number State | WA
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