Healthcare Provider Details

I. General information

NPI: 1609811322
Provider Name (Legal Business Name): COLUMBIA BASIN IMAGING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 SWIFT BLVD
RICHLAND WA
99352
US

IV. Provider business mailing address

PO BOX 5230
PASCO WA
99302-5201
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-5616
  • Fax: 509-943-9272
Mailing address:
  • Phone: 509-943-5616
  • Fax: 509-943-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DWANE T BRITTAIN
Title or Position: DIRECTOR
Credential: MD
Phone: 509-943-5616