Provider Demographics
NPI:1902843998
Name:YAKIMA CHEST CLINIC, P.C.
Entity Type:Organization
Organization Name:YAKIMA CHEST CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:I
Authorized Official - Last Name:MENASHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-575-7653
Mailing Address - Street 1:303 HOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3239
Mailing Address - Country:US
Mailing Address - Phone:509-575-7653
Mailing Address - Fax:
Practice Address - Street 1:303 HOLTON AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3239
Practice Address - Country:US
Practice Address - Phone:509-575-7653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7120124Medicaid
WA7120124Medicaid