Healthcare Provider Details

I. General information

NPI: 1396915112
Provider Name (Legal Business Name): AMERICAN MEDICAL DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SWIFT BLVD SUITE 130
RICHLAND WA
99352
US

IV. Provider business mailing address

780 SWIFT BLVD SUITE 130
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-7310
  • Fax: 509-943-7354
Mailing address:
  • Phone: 509-943-7310
  • Fax: 509-943-7354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberLR00001184
License Number StateWA

VIII. Authorized Official

Name: MR. KENNETH A NICHOLS
Title or Position: OWNER MANAGER
Credential: RPT PSGT
Phone: 509-943-7310