Provider Demographics
NPI:1144069808
Name:PACIFIC GASTRO HEALTH PLLC
Entity type:Organization
Organization Name:PACIFIC GASTRO HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FERDOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-823-0880
Mailing Address - Street 1:PO BOX 873787
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-3787
Mailing Address - Country:US
Mailing Address - Phone:360-823-0880
Mailing Address - Fax:360-823-0883
Practice Address - Street 1:8506 E MILL PLAIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2021
Practice Address - Country:US
Practice Address - Phone:360-823-0880
Practice Address - Fax:360-823-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1518960616OtherNPI