Provider Demographics
NPI:1861510851
Name:COLUMBIA BASIN IMAGING PC
Entity Type:Organization
Organization Name:COLUMBIA BASIN IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-5616
Mailing Address - Street 1:PO BOX 5230
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-5201
Mailing Address - Country:US
Mailing Address - Phone:509-943-5616
Mailing Address - Fax:509-943-9272
Practice Address - Street 1:945 GOETHALS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3552
Practice Address - Country:US
Practice Address - Phone:509-943-5616
Practice Address - Fax:509-943-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7038102Medicaid
WACR0034Medicare PIN
WA000346700Medicare PIN