Provider Demographics
NPI:1245506880
Name:PETER E SEDA MD FACC PS MID COLUMBIA HEART AND LUNG INSTITUTE
Entity type:Organization
Organization Name:PETER E SEDA MD FACC PS MID COLUMBIA HEART AND LUNG INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE CODER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN CPC
Authorized Official - Phone:509-943-3177
Mailing Address - Street 1:309 BRADLEY BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4381
Mailing Address - Country:US
Mailing Address - Phone:509-943-3177
Mailing Address - Fax:509-946-6576
Practice Address - Street 1:309 BRADLEY BLVD
Practice Address - Street 2:STE 205
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4381
Practice Address - Country:US
Practice Address - Phone:509-943-3177
Practice Address - Fax:509-946-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1471101Medicaid
GA060014429OtherRAILROAD MEDICARE
GA060014429OtherRAILROAD MEDICARE