Healthcare Provider Details

I. General information

NPI: 1376561530
Provider Name (Legal Business Name): LING MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W 27TH PL STE 300
KENNEWICK WA
99338-2261
US

IV. Provider business mailing address

4309 W 27TH PL STE 300
KENNEWICK WA
99338-2261
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-9848
  • Fax: 509-783-9860
Mailing address:
  • Phone: 509-783-9848
  • Fax: 509-783-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00031176
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006572
License Number StateWA

VIII. Authorized Official

Name: GRACE M LING
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-783-9848