Provider Demographics
NPI:1912048745
Name:ALLERGY & ASTHMA CENTER OF SW WASHINGTON LLC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CENTER OF SW WASHINGTON LLC
Other - Org Name:COLUMBIA ASTHMA AND ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-476-0624
Mailing Address - Street 1:43575 MISSION BLVD # 716
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5831
Mailing Address - Country:US
Mailing Address - Phone:360-609-7077
Mailing Address - Fax:
Practice Address - Street 1:1406 SE 164TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9663
Practice Address - Country:US
Practice Address - Phone:360-940-0810
Practice Address - Fax:360-567-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36116Medicare PIN