Provider Demographics
NPI:1275647422
Name:SOUTHWEST WASHINGTON THORACIC AND VASCULAR SURGERY PS
Entity Type:Organization
Organization Name:SOUTHWEST WASHINGTON THORACIC AND VASCULAR SURGERY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LITVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-735-8100
Mailing Address - Street 1:312 SE STONEMILL DR.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-3514
Mailing Address - Country:US
Mailing Address - Phone:360-735-3480
Mailing Address - Fax:360-735-3481
Practice Address - Street 1:200 NE MOTHER JOSEPH PL
Practice Address - Street 2:SUITE 330
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3299
Practice Address - Country:US
Practice Address - Phone:360-514-1854
Practice Address - Fax:360-514-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8863700Medicare PIN