Provider Demographics
NPI:1316180680
Name:TRI-CITY HEART CENTRE, INC
Entity Type:Organization
Organization Name:TRI-CITY HEART CENTRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-7609
Mailing Address - Street 1:750 SWIFT BLVD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3521
Mailing Address - Country:US
Mailing Address - Phone:509-946-7609
Mailing Address - Fax:509-943-5181
Practice Address - Street 1:750 SWIFT BLVD
Practice Address - Street 2:SUITE 13
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-946-7609
Practice Address - Fax:509-943-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011542207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1063858Medicaid
WAA07366Medicare UPIN
WAG000301347Medicare PIN