Healthcare Provider Details

I. General information

NPI: 1306933940
Provider Name (Legal Business Name): YAKIMA VALLEY MEMORIAL PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DRIVE
YAKIMA WA
98902
US

IV. Provider business mailing address

PO BOX 9787
YAKIMA WA
98909
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8825
  • Fax: 509-577-5056
Mailing address:
  • Phone: 509-574-3353
  • Fax: 509-225-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: KELLY WILLIAMS
Title or Position: MANAGER, PROVIDER DATA & ENROLLMENT
Credential:
Phone: 253-459-8009