Provider Demographics
NPI:1235765280
Name:PACIFIC PHOENIX GROUP PLLC
Entity Type:Organization
Organization Name:PACIFIC PHOENIX GROUP PLLC
Other - Org Name:TMS SERVICES OF VANCOUVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZBIRUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-507-7848
Mailing Address - Street 1:16420 SE MCGILLIVRAY BLVD STE 103-253
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3461
Mailing Address - Country:US
Mailing Address - Phone:425-507-7848
Mailing Address - Fax:
Practice Address - Street 1:1499 SE TECH CENTER PL STE 190
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5529
Practice Address - Country:US
Practice Address - Phone:360-773-6340
Practice Address - Fax:360-326-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty