Provider Demographics
NPI:1760658736
Name:VANCOUVER CLINIC INC
Entity Type:Organization
Organization Name:VANCOUVER CLINIC INC
Other - Org Name:ROSE QUARTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-397-1500
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1913
Mailing Address - Country:US
Mailing Address - Phone:360-397-3352
Mailing Address - Fax:360-601-8169
Practice Address - Street 1:ONE CENTER COURT
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-732-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANCOUVER CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR108364Medicare PIN