NPIMap

Organization Active NPI

Vannvei LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Clarkston, WA
National Provider Identifier
1124186804
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
H108 Issued in WA
Legal business name
VANNVEI LLC
Practice address
1221 Highland Ave
Clarkston, WA 99403
Phone
(509) 758-5511
Fax
(509) 721-9406
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teresa Gall
Title
Cfo
Phone
(509) 758-5511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X H108 WA Primary

Addresses

Primary practice location

1221 Highland Ave
Clarkston, WA 99403

Mailing address

PO Box 341
Lewiston, ID 83501-0341
Phone (509) 758-3311

Other identifiers 1

IdentifierTypeStateIssuer
003110900MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210112002739 WA Part A Provider - End-Stage Renal Disease Facility (ESRD) 1254743420 1 other NPI on this enrollment
Practice locations: Clarkston, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611619200000",
    "number": "1124186804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 341",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835010341",
            "telephone_number": "509-758-3311",
            "fax_number": "509-751-9406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "99403",
            "telephone_number": "509-758-5511",
            "fax_number": "509-721-9406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANNVEI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A",
        "authorized_official_last_name": "GALL",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-758-5511"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "WA",
            "license": "H108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003110900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkston, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.