Provider Demographics
NPI:1790382224
Name:HEART CENTRAL OF WASHINGTON, PLLC
Entity Type:Organization
Organization Name:HEART CENTRAL OF WASHINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-902-3625
Mailing Address - Street 1:1006 S 64TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2090
Mailing Address - Country:US
Mailing Address - Phone:509-902-3625
Mailing Address - Fax:509-676-3415
Practice Address - Street 1:1006 S 64TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2090
Practice Address - Country:US
Practice Address - Phone:509-902-3625
Practice Address - Fax:509-676-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty