Basic Information
| Provider Information | |||||||||
| NPI: | 1881651040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY CLINIC OF SW WASHINGTON, P.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 NE 87TH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986641989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602568836 | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 NE 87TH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986641989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602568836 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | DECHET | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3602568836 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.