Provider Demographics
NPI:1467798819
Name:COLUMBIA INTERVENTIONAL RADIOLOGY CONSULTING INC PS
Entity Type:Organization
Organization Name:COLUMBIA INTERVENTIONAL RADIOLOGY CONSULTING INC PS
Other - Org Name:NORTHWEST ENDOVASCULAR SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SARAVANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTHURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-528-6838
Mailing Address - Street 1:1341 SPAULDING AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-588-7613
Mailing Address - Fax:509-588-7611
Practice Address - Street 1:1341 SPAULDING AVENUE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-588-7613
Practice Address - Fax:509-588-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000391022085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty