Provider Demographics
NPI:1871770594
Name:VANCOUVER ALLERGY AND ASTHMA CENTER PLLC
Entity type:Organization
Organization Name:VANCOUVER ALLERGY AND ASTHMA CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-695-8553
Mailing Address - Street 1:14508 NE 20TH AVE
Mailing Address - Street 2:#200
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6418
Mailing Address - Country:US
Mailing Address - Phone:360-695-8553
Mailing Address - Fax:360-737-3713
Practice Address - Street 1:14508 NE 20TH AVE
Practice Address - Street 2:#200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6418
Practice Address - Country:US
Practice Address - Phone:360-695-8553
Practice Address - Fax:360-737-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043457261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8854032Medicare PIN