Provider Demographics
NPI:1700963782
Name:E.N.T.-FACIAL PLASTIC SURGERY ASSOCIATES, PLLC.
Entity type:Organization
Organization Name:E.N.T.-FACIAL PLASTIC SURGERY ASSOCIATES, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PALMER
Authorized Official - Middle Name:P
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-453-5300
Mailing Address - Street 1:3999 ENGLEWOOD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6335
Mailing Address - Country:US
Mailing Address - Phone:509-453-5300
Mailing Address - Fax:509-453-1200
Practice Address - Street 1:3999 ENGLEWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6335
Practice Address - Country:US
Practice Address - Phone:509-453-5300
Practice Address - Fax:509-453-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128531Medicaid
WA7128531Medicaid