Provider Demographics
NPI:1982074621
Name:ECLIPSE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ECLIPSE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGELGESANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-259-4069
Mailing Address - Street 1:3240 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8509
Mailing Address - Country:US
Mailing Address - Phone:360-790-0767
Mailing Address - Fax:
Practice Address - Street 1:3240 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8509
Practice Address - Country:US
Practice Address - Phone:360-790-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory