Healthcare Provider Details

I. General information

NPI: 1619032075
Provider Name (Legal Business Name): CENTRAL WASHINGTON GASTROENTEROLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E PENNY RD STE C
WENATCHEE WA
98801-8127
US

IV. Provider business mailing address

175 E PENNY RD STE C
WENATCHEE WA
98801-8127
US

V. Phone/Fax

Practice location:
  • Phone: 509-669-3431
  • Fax: 509-665-8043
Mailing address:
  • Phone: 509-669-3431
  • Fax: 509-665-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD A BASSETT
Title or Position: INCORPORATOR
Credential: MD, FACG
Phone: 509-669-3431