Provider Demographics
NPI:1013939099
Name:YAKIMA GASTROENTEROLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:YAKIMA GASTROENTEROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-248-7849
Mailing Address - Street 1:PO BOX 2947
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2947
Mailing Address - Country:US
Mailing Address - Phone:509-248-7849
Mailing Address - Fax:509-249-5042
Practice Address - Street 1:3909 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 130
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4880
Practice Address - Country:US
Practice Address - Phone:509-248-6616
Practice Address - Fax:509-248-4983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7114044Medicaid
WACK6157Medicare PIN
WA7114044Medicaid