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Organization

AVA INC.

Active
Other names
Collier Prosthetics
Organization subpart
No

Provider details

NPI number
Authorized official
VICTORIA MILLER (OFFICE MANAGER)
(360) 423-0459
Entity
Organization

Contact information

Practice address
1113 VANDERCOOK WAY, SUITE 120, LONGVIEW, WA 98632-4024
(360) 423-0459
(360) 575-1144
Mailing address
PO BOX 909, LONGVIEW, WA 98632-7568
(360) 423-0459
(360) 575-1144

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
240332
OR
01
883583000
REGENCE
OR
05
9050931
WA
Enumeration date
10/03/2006
Last updated
02/18/2011
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