Provider Demographics
NPI:1265527162
Name:VANCOUVER ENT AND ENT OF THE NORTHWEST PLLC
Entity type:Organization
Organization Name:VANCOUVER ENT AND ENT OF THE NORTHWEST PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-449-6612
Mailing Address - Street 1:1405 SE 164TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9644
Mailing Address - Country:US
Mailing Address - Phone:360-256-4425
Mailing Address - Fax:360-260-7249
Practice Address - Street 1:1405 SE 164TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9644
Practice Address - Country:US
Practice Address - Phone:360-256-4425
Practice Address - Fax:360-260-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA169197OtherWA DEPT OF L&I
WA15018260OtherREGENCE FIRST CHOICE 65
WA8933204OtherWA CRIME VICTIMS
WA7135502Medicaid
WA15018260OtherREGENCE FIRST CHOICE 65