Healthcare Provider Details

I. General information

NPI: 1194263608
Provider Name (Legal Business Name): KADLEC REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 FOWLER ST
RICHLAND WA
99352-4714
US

IV. Provider business mailing address

888 SWIFT BLVD
RICHLAND WA
99352-3514
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-1654
  • Fax: 509-943-5652
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECREATRY FOR ENROLLMENT
Credential:
Phone: 425-358-9786