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NPI Code Detail

MEDICARE: MEMORIAL PHYSICIANS, PLLC

MEDICARE: MEMORIAL PHYSICIANS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center602902835WA

General Provider Information

NPI Number : 1912203761
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIAL PHYSICIANS, PLLC
Provider Business Mailing Address
First Line : 3800 SUMMITVIEW AVE
Second Line :
City : YAKIMA
State : WA
Zip : 98902-2715
Country : US
Telephone Number : 509-248-7849
Fax Number :
Provider Business Practice Location Address
First Line : 4003 CREEKSIDE LOOP
Second Line :
City : YAKIMA
State : WA
Zip : 98908-3962
Country : US
Telephone Number : 509-965-1980
Fax Number : 509-225-2713
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : TIMOTHY REED
Credential :
Telephone Number : 509-248-7849
Provider Enumeration Date : 01/26/2011
Last Update Date : 01/29/2020

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Directions to “MEMORIAL PHYSICIANS, PLLC ” Practice Location

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