1992105613 NPI number — COLUMBIA BASIN PAIN MANAGEMENT INSTITUTE, PLLC

Table of content: (NPI 1992105613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992105613 NPI number — COLUMBIA BASIN PAIN MANAGEMENT INSTITUTE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA BASIN PAIN MANAGEMENT INSTITUTE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COLUMBIA BASIN MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992105613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 FOWLER ST STE 1B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-4719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-585-6318
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 FOWLER ST STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-4719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-585-6318
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KURTZ
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
REGISTERED AGENT
Authorized Official Telephone Number:
509-582-3549

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH 00002564 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD 00048680 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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