Provider Demographics
NPI:1891785903
Name:SOUTHWEST WASHINGTON MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHWEST WASHINGTON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:360-514-6087
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-1600
Mailing Address - Country:US
Mailing Address - Phone:360-514-2294
Mailing Address - Fax:360-514-2003
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-514-2294
Practice Address - Fax:360-514-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000070282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4923315Medicaid
WA4923315OtherNABP NUMBER