Provider Demographics
NPI:1851348999
Name:LONGVIEW VA CLINIC
Entity Type:Organization
Organization Name:LONGVIEW VA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-254-0339
Mailing Address - Street 1:1801 1ST AVE
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3270
Mailing Address - Country:US
Mailing Address - Phone:360-636-7822
Mailing Address - Fax:360-636-7893
Practice Address - Street 1:1801 1ST AVE
Practice Address - Street 2:SUITE 4C
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3270
Practice Address - Country:US
Practice Address - Phone:360-636-7822
Practice Address - Fax:360-636-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA