Provider Demographics
NPI:1629016522
Name:THORACIC & VASCULAR CENTER OF KITSAP COUNTY INC PS
Entity Type:Organization
Organization Name:THORACIC & VASCULAR CENTER OF KITSAP COUNTY INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-479-4228
Mailing Address - Street 1:1225 CAMPBELL WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3351
Mailing Address - Country:US
Mailing Address - Phone:360-479-4228
Mailing Address - Fax:360-478-7240
Practice Address - Street 1:1225 CAMPBELL WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3351
Practice Address - Country:US
Practice Address - Phone:360-479-4228
Practice Address - Fax:360-478-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7116726Medicaid