Basic Information
| Provider Information | |||||||||
| NPI: | 1437296910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBIA PEDIATRICS P.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 RED APPLE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096638767 | ||||||||
| FaxNumber: | 5096631421 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 RED APPLE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096638767 | ||||||||
| FaxNumber: | 5096631421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5096638767 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 208000000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.