Provider Demographics
NPI:1932311107
Name:MID-COLUMBIA MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:MID-COLUMBIA MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-735-1173
Mailing Address - Street 1:510 N COLORADO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7770
Mailing Address - Country:US
Mailing Address - Phone:509-735-6689
Mailing Address - Fax:509-735-6998
Practice Address - Street 1:510 N COLORADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7770
Practice Address - Country:US
Practice Address - Phone:509-735-6689
Practice Address - Fax:509-735-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7097868Medicaid
WA7097868Medicaid