Provider Demographics
NPI:1619149960
Name:THE VANCOUVER CLINIC INC PS
Entity Type:Organization
Organization Name:THE VANCOUVER CLINIC INC PS
Other - Org Name:THE VANCOUVER CLINIC, AMBULATORY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SEEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-882-2778
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4896
Mailing Address - Country:US
Mailing Address - Phone:360-397-3352
Mailing Address - Fax:360-604-1771
Practice Address - Street 1:700 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1913
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE VANCOUVER CLINIC INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7091002Medicaid
WA213062OtherL & I
WA7091002Medicaid