Provider Demographics
NPI:1851538219
Name:BADGER CANYON FAMILY HEALTH AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:BADGER CANYON FAMILY HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:PHIPPS
Authorized Official - Last Name:DRAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-783-4949
Mailing Address - Street 1:10121 W CLEARWATER AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-783-4949
Mailing Address - Fax:509-783-6827
Practice Address - Street 1:10121 W CLEARWATER AVE
Practice Address - Street 2:STE 102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-783-4949
Practice Address - Fax:509-783-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60036526261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center