Provider Demographics
NPI:1710045141
Name:COLUMBIA NEUROSURGERY & SPINE PLLC
Entity Type:Organization
Organization Name:COLUMBIA NEUROSURGERY & SPINE PLLC
Other - Org Name:MATTHEW FEWEL, MD PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARRETT REED
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MBA
Authorized Official - Phone:509-942-3080
Mailing Address - Street 1:833 SWIFT BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3513
Mailing Address - Country:US
Mailing Address - Phone:509-942-3080
Mailing Address - Fax:509-942-3085
Practice Address - Street 1:833 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3513
Practice Address - Country:US
Practice Address - Phone:509-942-3080
Practice Address - Fax:509-942-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044896207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122167Medicaid
WA0199144OtherLABOR AND INDUSTRY
WA4330FEOtherASURIS
WA212550OtherLABOR AND INDUSTRY
WA8461592Medicaid
WAP57971Medicare UPIN
WA1122167Medicaid
WA8461592Medicaid