Provider Demographics
NPI:1932130234
Name:MEDI-CENTER GROUP
Entity Type:Organization
Organization Name:MEDI-CENTER GROUP
Other - Org Name:WESTSIDE MEDI-CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-965-1770
Mailing Address - Street 1:4001 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3345
Mailing Address - Country:US
Mailing Address - Phone:509-965-1770
Mailing Address - Fax:509-966-4209
Practice Address - Street 1:4001 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3345
Practice Address - Country:US
Practice Address - Phone:509-965-1770
Practice Address - Fax:509-966-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0296490001Medicare NSC
WAG000199700Medicare PIN