Basic Information
| Provider Information | |||||||||
| NPI: | 1740475581 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBIA NEUROLOGY & PAIN MANAGEMENT, PS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLUMBIA NEUROLOGY, PS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 WELLSIAN WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993524120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099467931 | ||||||||
| FaxNumber: | 5099467223 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 WELLSIAN WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993524120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099467931 | ||||||||
| FaxNumber: | 5099467223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ZHANG | ||||||||
| AuthorizedOfficialFirstName: | HUI-JUAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5099467931 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD, PHD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00040298 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0155649 | 01 | WA | L&I | OTHER | DA6591 | 01 | WA | RAILROAD MEDICARE GROUP | OTHER | 1114537 | 05 | WA | MEDICAID |