Provider Demographics
NPI:1851572523
Name:YAKIMA UROLOGY ASSOCIATES,PLLC
Entity Type:Organization
Organization Name:YAKIMA UROLOGY ASSOCIATES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-249-3900
Mailing Address - Street 1:2500 RACQUET LN
Mailing Address - Street 2:STE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6114
Mailing Address - Country:US
Mailing Address - Phone:509-249-3900
Mailing Address - Fax:509-573-9539
Practice Address - Street 1:100 E JACKSON AVE
Practice Address - Street 2:STE 105
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3692
Practice Address - Country:US
Practice Address - Phone:509-249-3900
Practice Address - Fax:509-573-9539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAKIMA UROLOGY ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG115145900Medicare PIN
WACC9011Medicare PIN