Provider Demographics
NPI:1093721409
Name:COLUMBIA BASIN CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:COLUMBIA BASIN CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MGR OF PLLC
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:RAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-2781
Mailing Address - Street 1:945 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3508
Mailing Address - Country:US
Mailing Address - Phone:509-943-2781
Mailing Address - Fax:509-946-8590
Practice Address - Street 1:945 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3508
Practice Address - Country:US
Practice Address - Phone:509-943-2781
Practice Address - Fax:509-946-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104561Medicaid
060050067OtherRAILROAD MEDICARE
OR239010Medicaid
060050067OtherRAILROAD MEDICARE