Provider Demographics
NPI:1962563718
Name:THE WOMENS CLINIC OF VANCOUVER PS
Entity type:Organization
Organization Name:THE WOMENS CLINIC OF VANCOUVER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VIRTUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-256-4060
Mailing Address - Street 1:2101 NE 139TH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2309
Mailing Address - Country:US
Mailing Address - Phone:360-256-4060
Mailing Address - Fax:360-256-0103
Practice Address - Street 1:2101 NE 139TH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2309
Practice Address - Country:US
Practice Address - Phone:360-256-4060
Practice Address - Fax:360-256-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D1050187OtherCUA ID
WA7827702Medicaid
WACP7561OtherMEDICARE RR
WA7827702Medicaid