Healthcare Provider Details

I. General information

NPI: 1124288527
Provider Name (Legal Business Name): CENTRAL WASHINGTON GASTROENTEROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HOSPITAL WAY
BREWSTER WA
98812-2517
US

IV. Provider business mailing address

175 E PENNY RD SUITE C
WENATCHEE WA
98801-8127
US

V. Phone/Fax

Practice location:
  • Phone: 509-664-0530
  • Fax: 509-665-8043
Mailing address:
  • Phone: 509-664-0530
  • Fax: 509-665-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number602659073
License Number StateWA

VIII. Authorized Official

Name: GERALD BASSETT
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 509-664-0530