Healthcare Provider Details

I. General information

NPI: 1821634312
Provider Name (Legal Business Name): COLUMBIA BASIN MOBILE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 PLATINUM PL
WEST RICHLAND WA
99353-5108
US

IV. Provider business mailing address

1357 PLATINUM PL
WEST RICHLAND WA
99353-5108
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-1022
  • Fax: 877-839-8911
Mailing address:
  • Phone: 509-942-1022
  • Fax: 877-839-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL SHOEMAKER
Title or Position: OWNER
Credential:
Phone: 509-942-1022