Basic Information
| Provider Information | |||||||||
| NPI: | 1275647422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST WASHINGTON THORACIC AND VASCULAR SURGERY PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 SE STONEMILL DR. | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986843514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607353480 | ||||||||
| FaxNumber: | 3607353481 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 NE MOTHER JOSEPH PL | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986643299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605141854 | ||||||||
| FaxNumber: | 3605146063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 03/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | LITVIN | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3607358100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.