Provider Demographics
NPI:1316715295
Name:DISRUPTION HEALTHCARE PLLC
Entity type:Organization
Organization Name:DISRUPTION HEALTHCARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-554-6128
Mailing Address - Street 1:2633 QUARTERHORSE WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9496
Mailing Address - Country:US
Mailing Address - Phone:509-554-6128
Mailing Address - Fax:
Practice Address - Street 1:969 STEVENS DR STE 3A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3558
Practice Address - Country:US
Practice Address - Phone:509-713-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty