Provider Demographics
NPI:1306905138
Name:J. HAMILTON LICHT, M.D., P.C.
Entity type:Organization
Organization Name:J. HAMILTON LICHT, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J. HAMILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-248-6292
Mailing Address - Street 1:315 HOLTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3254
Mailing Address - Country:US
Mailing Address - Phone:509-248-6292
Mailing Address - Fax:509-248-9134
Practice Address - Street 1:315 HOLTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3254
Practice Address - Country:US
Practice Address - Phone:509-248-6292
Practice Address - Fax:509-248-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0021581207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1301506Medicaid
DE5146OtherRAILROAD MEDICARE
WAA06572Medicare UPIN
DE5146OtherRAILROAD MEDICARE
WA1301506Medicaid