Basic Information
| Provider Information | |||||||||
| NPI: | 1417131228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAKIMA VALLEY SURGICAL ASSOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 SOUTH 11TH STREET | ||||||||
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| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989442240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098377722 | ||||||||
| FaxNumber: | 5098372587 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S 11TH ST | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989442240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098377722 | ||||||||
| FaxNumber: | 5098372587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2007 | ||||||||
| LastUpdateDate: | 12/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | ELERDING | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5098377722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00018116 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.