Healthcare Provider Details

I. General information

NPI: 1972526895
Provider Name (Legal Business Name): YAKIMA GASTROENTEROLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 CREEKSIDE LOOP SUITE 130
YAKIMA WA
98902-4880
US

IV. Provider business mailing address

PO BOX 2947
YAKIMA WA
98907-2947
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-6616
  • Fax: 509-248-4983
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-249-5042

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: JIM W SIMMONS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 509-248-7849