Provider Demographics
NPI:1831391572
Name:CENTRAL WASHINGTON GASTROENTEROLOGY
Entity type:Organization
Organization Name:CENTRAL WASHINGTON GASTROENTEROLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-664-0530
Mailing Address - Street 1:175 E PENNY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-8127
Mailing Address - Country:US
Mailing Address - Phone:509-664-0530
Mailing Address - Fax:509-665-8043
Practice Address - Street 1:175 E PENNY RD
Practice Address - Street 2:SUITE C
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-8127
Practice Address - Country:US
Practice Address - Phone:509-664-0530
Practice Address - Fax:509-665-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX IDENTIFICATON
WAG8870111Medicare PIN