Provider Demographics
NPI:1942685003
Name:YAKIMA UROLOGY AT MEMORIAL TR
Entity Type:Organization
Organization Name:YAKIMA UROLOGY AT MEMORIAL TR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-403-1272
Mailing Address - Street 1:2500 RACQUET LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6114
Mailing Address - Country:US
Mailing Address - Phone:509-249-3913
Mailing Address - Fax:509-853-1530
Practice Address - Street 1:2500 RACQUET LN
Practice Address - Street 2:STE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6114
Practice Address - Country:US
Practice Address - Phone:509-249-3913
Practice Address - Fax:509-853-1530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAKIMA VALLEY MEMORIAL HOSPITAL ASSN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-29
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty