Healthcare Provider Details

I. General information

NPI: 1619263936
Provider Name (Legal Business Name): MEMORIAL PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E JACKSON AVE STE. 102
ELLENSBURG WA
98926-3692
US

IV. Provider business mailing address

3800 SUMMITVIEW AVE
YAKIMA WA
98902-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-5300
  • Fax: 509-225-2703
Mailing address:
  • Phone: 509-248-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number602902835
License Number StateWA

VIII. Authorized Official

Name: TIMOTHY REED
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 509-248-7849