Healthcare Provider Details

I. General information

NPI: 1689840670
Provider Name (Legal Business Name): TRI-CITIES DIGESTIVE HEALTH CENTER, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SWIFT BLVD STE 280
RICHLAND WA
99352-3582
US

IV. Provider business mailing address

780 SWIFT BLVD STE 280
RICHLAND WA
99352-3582
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-9747
  • Fax: 509-946-0970
Mailing address:
  • Phone: 509-946-9747
  • Fax: 509-946-0970

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: SOMPRAK BOONPONGMANEE
Title or Position: OWNER
Credential: M.D.
Phone: 509-946-9747