Healthcare Provider Details

I. General information

NPI: 1508390543
Provider Name (Legal Business Name): YAKIMA ORTHOPEDICS AT MEMORIAL TR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N 16TH AVE
YAKIMA WA
98902-1347
US

IV. Provider business mailing address

1211 N 16TH AVE
YAKIMA WA
98902-1347
US

V. Phone/Fax

Practice location:
  • Phone: 509-454-8888
  • Fax: 509-453-0061
Mailing address:
  • Phone: 509-454-8888
  • Fax: 509-453-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY REED
Title or Position: VP/CFO
Credential:
Phone: 509-249-5067