Provider Demographics
NPI:1538381884
Name:VANCOUVER PRIMARY CARE PS
Entity type:Organization
Organization Name:VANCOUVER PRIMARY CARE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:TONGHUA
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-896-3188
Mailing Address - Street 1:11719 NE 95TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2444
Mailing Address - Country:US
Mailing Address - Phone:360-896-3188
Mailing Address - Fax:360-896-3122
Practice Address - Street 1:11719 NE 95TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-2444
Practice Address - Country:US
Practice Address - Phone:360-896-3188
Practice Address - Fax:360-896-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB38637Medicare PIN
WAH48155Medicare UPIN