Healthcare Provider Details

I. General information

NPI: 1932311107
Provider Name (Legal Business Name): MID-COLUMBIA MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N COLORADO ST SUITE A
KENNEWICK WA
99336-7770
US

IV. Provider business mailing address

510 N COLORADO ST SUITE A
KENNEWICK WA
99336-7770
US

V. Phone/Fax

Practice location:
  • Phone: 509-735-6689
  • Fax: 509-735-6998
Mailing address:
  • Phone: 509-735-6689
  • Fax: 509-735-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID STRUTZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-735-1173