Provider Demographics
NPI:1669659413
Name:TRI-CITY ANESTHESIA AND PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:TRI-CITY ANESTHESIA AND PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-0900
Mailing Address - Street 1:221 WELLSIAN WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4120
Mailing Address - Country:US
Mailing Address - Phone:509-946-0900
Mailing Address - Fax:509-946-8900
Practice Address - Street 1:221 WELLSIAN WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4120
Practice Address - Country:US
Practice Address - Phone:509-946-0900
Practice Address - Fax:509-946-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114198Medicaid
P00197705OtherMEDICARE RR
WA8808637Medicare PIN