Provider Demographics
NPI:1659858132
Name:VANCOUVER VEIN & SURGICAL CENTER
Entity Type:Organization
Organization Name:VANCOUVER VEIN & SURGICAL CENTER
Other - Org Name:VANCOUVER VEIN & SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-448-2047
Mailing Address - Street 1:13115 NE 4TH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5965
Mailing Address - Country:US
Mailing Address - Phone:360-448-2047
Mailing Address - Fax:360-450-2289
Practice Address - Street 1:13115 NE 4TH ST STE 230
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5965
Practice Address - Country:US
Practice Address - Phone:360-448-2047
Practice Address - Fax:360-450-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty