Vancouver ENT and ENT of the Northwest PLLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

VANCOUVER ENT AND ENT OF THE NORTHWEST PLLC

Doing business as

Vancouver Ear, Nose & Throat Head & Neck Surgery Center

Practice address

14411 NE 20TH Ave Ste 101
Vancouver, WA 98686-6432

Phone

(360) 256-4425

Fax

(360) 260-7249

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Karen Kennedy

Title

Practice Manager

Phone

(360) 449-6612

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Vancouver Ear, Nose & Throat Head & Neck Surgery Center Doing business as

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1639268469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 SE 164TH AVE STE 102",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839644",
            "telephone_number": "360-256-4425",
            "fax_number": "360-260-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14411 NE 20TH AVE STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986866432",
            "telephone_number": "360-256-4425",
            "fax_number": "360-260-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANCOUVER ENT AND ENT OF THE NORTHWEST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-10-29",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "360-449-6612",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7135502",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA DEPT OF L&I",
            "identifier": "204729",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA CRIME VICTIMS",
            "identifier": "8940474",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vancouver Ear, Nose & Throat Head & Neck Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.

Verify at the official NPI Registry.