Active NPI
George S. Fortner, M.D.
- Vascular Surgery Physician
- Longview, WA
National Provider Identifier
1154329324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- MD00016906
- Practice address
- 1615 Delaware St
Longview, WA 98632-2310 - Phone
- (360) 501-3500
- Fax
- (360) 501-3555
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | MD00016906 | WA | Primary |
Addresses
Primary practice location
1615 Delaware St
Longview, WA 98632-2310
Mailing address
PO Box 3002
Longview, WA 98632-0302
Phone (360) 414-2048
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8395006 | Medicaid | WA | |
| 8943476 | Other | WA | CRIME VICTIMS |
| 160747 | Medicaid | OR | |
| 0217049 | Other | WA | LABOR & IND. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00034927 | WA | MD | Surgery Physician |
| MD00016906 | WA | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longview Surgical Group | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Surgery Physician
- Longview, WA
- NPI 1851307078
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194998400000",
"number": "1154329324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3002",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986320302",
"telephone_number": "360-414-2048",
"fax_number": "360-575-6749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 DELAWARE ST",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322310",
"telephone_number": "360-501-3500",
"fax_number": "360-501-3555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTNER",
"first_name": "GEORGE",
"middle_name": "S.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-12",
"last_updated": "2007-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "WA",
"license": "MD00016906",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8395006",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8943476",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "160747",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & IND.",
"identifier": "0217049",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.