Provider Demographics
NPI:1710603907
Name:COMMUNITY VASCULAR WASHINGTON, PLLC
Entity Type:Organization
Organization Name:COMMUNITY VASCULAR WASHINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMR
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-SERGANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-215-5946
Mailing Address - Street 1:3902 CREEKSIDE LOOP STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4876
Mailing Address - Country:US
Mailing Address - Phone:509-215-5946
Mailing Address - Fax:509-233-4585
Practice Address - Street 1:3902 CREEKSIDE LOOP STE 110
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4876
Practice Address - Country:US
Practice Address - Phone:509-223-4684
Practice Address - Fax:509-245-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty