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General NPI Number Information
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NPI Number | 1730180746
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Entity Type | Organization
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Legal Business Name | CREEKSIDE ORTHOPEDICS, PLLC
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 3907 CREEKSIDE LOOP STE. 100
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City | YAKIMA
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State | WA
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Zip | 98902-4879
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Country | US
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Telephone | 509-457-1900
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Fax | 509-853-2700
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Provider Business Mailing Address
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Address Line | PO BOX 8051
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City | YAKIMA
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State | WA
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Zip | 98908-0051
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Country | US
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Telephone | 509-469-1903
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Fax | 509-469-1905
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Authorized Official
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Title or Position | CEO
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Name | JOHN S PLACE
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Credential | MD
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Telephone | 509-457-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD0012321
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License Number State | WA
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