Provider Demographics
NPI:1639351190
Name:NORTHERN DESERT CARDIOLOGY PC
Entity Type:Organization
Organization Name:NORTHERN DESERT CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:ZUROSKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-1172
Mailing Address - Street 1:1110 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3302
Mailing Address - Country:US
Mailing Address - Phone:509-943-1172
Mailing Address - Fax:509-946-6278
Practice Address - Street 1:1110 GILLMORE AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3302
Practice Address - Country:US
Practice Address - Phone:509-943-1172
Practice Address - Fax:509-946-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000304790OtherMEDICARE INDIVIDUAL
WA7069735Medicaid