Provider Demographics
NPI:1093240301
Name:MEMORIAL PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:MEMORIAL PHYSICIANS, PLLC
Other - Org Name:YAKIMA PODIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, VP
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-248-7849
Mailing Address - Street 1:3800 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2715
Mailing Address - Country:US
Mailing Address - Phone:509-248-7849
Mailing Address - Fax:509-248-8291
Practice Address - Street 1:1607 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 140
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4882
Practice Address - Country:US
Practice Address - Phone:509-453-4614
Practice Address - Fax:509-225-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602902835213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty