Provider Demographics
NPI:1689840670
Name:TRI-CITIES DIGESTIVE HEALTH CENTER, P.S.
Entity Type:Organization
Organization Name:TRI-CITIES DIGESTIVE HEALTH CENTER, P.S.
Other - Org Name:TRI-CITIES DIGESTIVE HEALTH ASC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOMPRAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONPONGMANEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-9747
Mailing Address - Street 1:780 SWIFT BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3582
Mailing Address - Country:US
Mailing Address - Phone:509-946-9747
Mailing Address - Fax:509-946-0970
Practice Address - Street 1:780 SWIFT BLVD STE 280
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3582
Practice Address - Country:US
Practice Address - Phone:509-946-9747
Practice Address - Fax:509-946-0970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-CITIES DIGESTIVE HEALTH CENTER, P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7109432Medicaid
GAB21177Medicare PIN