Provider Demographics
NPI:1952068298
Name:PUGET SOUND GASTROENTEROLOGY, PLLC
Entity Type:Organization
Organization Name:PUGET SOUND GASTROENTEROLOGY, PLLC
Other - Org Name:TRI-CITIES ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-205-3464
Mailing Address - Street 1:7114 W HOOD PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6712
Mailing Address - Country:US
Mailing Address - Phone:509-734-4885
Mailing Address - Fax:509-734-2576
Practice Address - Street 1:7114 W HOOD PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6712
Practice Address - Country:US
Practice Address - Phone:509-734-4885
Practice Address - Fax:509-734-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical