Provider Demographics
NPI:1194882100
Name:COLUMBIA BASIN WELLNESS CLINIC, INC.
Entity type:Organization
Organization Name:COLUMBIA BASIN WELLNESS CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-667-1357
Mailing Address - Street 1:115 W HERMISTON AVE
Mailing Address - Street 2:SUITE 100 C
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1746
Mailing Address - Country:US
Mailing Address - Phone:541-667-8357
Mailing Address - Fax:541-667-8357
Practice Address - Street 1:115 W HERMISTON AVE
Practice Address - Street 2:SUITE 100 C
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1746
Practice Address - Country:US
Practice Address - Phone:541-667-8357
Practice Address - Fax:541-667-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center