Provider Demographics
NPI:1639105992
Name:ELLENSBURG PEDIATRICS PLLC
Entity Type:Organization
Organization Name:ELLENSBURG PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-962-5437
Mailing Address - Street 1:611 S CHESTNUT ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-4815
Mailing Address - Country:US
Mailing Address - Phone:509-962-5437
Mailing Address - Fax:509-962-5438
Practice Address - Street 1:611 S CHESTNUT ST
Practice Address - Street 2:SUITE E
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-4815
Practice Address - Country:US
Practice Address - Phone:509-962-5437
Practice Address - Fax:509-962-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health