Provider Demographics
NPI:1780751818
Name:PARK PLACE MEDICAL CENTER
Entity type:Organization
Organization Name:PARK PLACE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BESSAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-828-8008
Mailing Address - Street 1:13115 NE 4TH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5957
Mailing Address - Country:US
Mailing Address - Phone:360-828-8008
Mailing Address - Fax:360-326-1609
Practice Address - Street 1:13115 NE 4TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5957
Practice Address - Country:US
Practice Address - Phone:360-828-8008
Practice Address - Fax:360-326-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041827261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care