Provider Demographics
NPI:1124288527
Name:CENTRAL WASHINGTON GASTROENTEROLOGY, PC
Entity type:Organization
Organization Name:CENTRAL WASHINGTON GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-664-0530
Mailing Address - Street 1:175 E PENNY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-8127
Mailing Address - Country:US
Mailing Address - Phone:509-664-0530
Mailing Address - Fax:509-665-8043
Practice Address - Street 1:507 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-2517
Practice Address - Country:US
Practice Address - Phone:509-664-0530
Practice Address - Fax:509-665-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602659073207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8865223Medicare PIN