Healthcare Provider Details

I. General information

NPI: 1003987868
Provider Name (Legal Business Name): TRI-CITIES DIGESTIVE HEALTH CENTER, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8819 W VICTORIA AVE
KENNEWICK WA
99336
US

IV. Provider business mailing address

8819 W VICTORIA AVE
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-460-5500
  • Fax: 509-460-5111
Mailing address:
  • Phone: 509-460-5500
  • Fax: 509-460-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHAYANIN BOONPONGMANEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-460-5500