# ADVANCED GASTROENTEROLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962706655
- **Authorized official:** SAMUEL K SIM (PARTNER)
- **Authorized official phone:** (360) 946-4313

## Contact information

- **Practice address:** 3250 SE 164TH AVE STE 205, VANCOUVER, WA 98683-9313
- **Practice address phone:** (360) 946-4313
- **Practice address fax:** (360) 314-2067
- **Mailing address:** 3250 SE 164TH AVE STE 205, VANCOUVER, WA 98683-9313
- **Mailing address phone:** (360) 946-4313
- **Mailing address fax:** (360) 314-2067

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 50-C0001292 | WA | Yes |

## Other

- **Enumeration date:** 01/10/2011
- **Last updated:** 11/07/2024