Provider Demographics
NPI:1689612046
Name:TRI CITY EAR NOSE & THROAT PS
Entity Type:Organization
Organization Name:TRI CITY EAR NOSE & THROAT PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RINDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-586-8368
Mailing Address - Street 1:911 S WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5600
Mailing Address - Country:US
Mailing Address - Phone:509-586-8368
Mailing Address - Fax:509-586-2525
Practice Address - Street 1:911 S WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5600
Practice Address - Country:US
Practice Address - Phone:509-586-8368
Practice Address - Fax:509-586-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA76968OtherLABOR & INDUSTRIES
WA7097546Medicaid
WA7097546Medicaid