Provider Demographics
NPI:1114995933
Name:COLUMBIA BASIN NEUROSURGERY PS
Entity Type:Organization
Organization Name:COLUMBIA BASIN NEUROSURGERY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THORNTON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-4708
Mailing Address - Street 1:PO BOX 1663
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0031
Mailing Address - Country:US
Mailing Address - Phone:509-529-1284
Mailing Address - Fax:
Practice Address - Street 1:800 SWIFT BLVD
Practice Address - Street 2:STE 240
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3549
Practice Address - Country:US
Practice Address - Phone:509-946-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041443207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB33680Medicare PIN