Provider Demographics
NPI:1609811322
Name:COLUMBIA BASIN IMAGING PC
Entity Type:Organization
Organization Name:COLUMBIA BASIN IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DWANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRITTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-5616
Mailing Address - Street 1:PO BOX 5230
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-5201
Mailing Address - Country:US
Mailing Address - Phone:509-943-5616
Mailing Address - Fax:509-943-9272
Practice Address - Street 1:888 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-943-5616
Practice Address - Fax:509-943-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA599OtherGROUP HEALTH NUMBER
WA7038102Medicaid
OR196105Medicaid
WA19100OtherWORKERS COMP (L&)
OR196105Medicaid
WA599OtherGROUP HEALTH NUMBER