Basic Information
| Provider Information | |||||||||
| NPI: | 1225145105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI-CITIES COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1452 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993011223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095472204 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 W COURT ST | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095472204 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | CARDOZA | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL STAFF SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5095431920 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QD0000X | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM1000X | N | Ambulatory Health Care Facilities | Clinic/Center | Migrant Health | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 7401201 | 05 | WA | MEDICAID | 7050883 | 05 | WA | MEDICAID | 7401425 | 05 | WA | MEDICAID | 5015854 | 05 | WA | MEDICAID | 7059892 | 05 | WA | MEDICAID | 7900954 | 05 | WA | MEDICAID | 1980523 | 05 | WA | MEDICAID |