Provider Demographics
NPI:1134498041
Name:COLUMBIA UNITED PROVIDERS
Entity Type:Organization
Organization Name:COLUMBIA UNITED PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-449-8938
Mailing Address - Street 1:19120 SE 34TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1429
Mailing Address - Country:US
Mailing Address - Phone:360-449-8861
Mailing Address - Fax:360-449-8862
Practice Address - Street 1:19120 SE 34TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1429
Practice Address - Country:US
Practice Address - Phone:360-449-8861
Practice Address - Fax:360-449-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization