Provider Demographics
NPI:1437328085
Name:KENNEWICK RADIOLOGY GROUP PC
Entity Type:Organization
Organization Name:KENNEWICK RADIOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-941-4365
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-1441
Mailing Address - Country:US
Mailing Address - Phone:509-586-5779
Mailing Address - Fax:509-586-5178
Practice Address - Street 1:174 FIRST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624
Practice Address - Country:US
Practice Address - Phone:360-642-6304
Practice Address - Fax:360-642-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7138209Medicaid
OR006814Medicaid
WA8867684Medicare PIN
WADG7339Medicare PIN