Provider Demographics
NPI:1528255296
Name:TRI-CITIES PHYSICAL MED & REHAB
Entity type:Organization
Organization Name:TRI-CITIES PHYSICAL MED & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WING
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-1211
Mailing Address - Street 1:943 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3508
Mailing Address - Country:US
Mailing Address - Phone:509-943-1211
Mailing Address - Fax:509-946-9090
Practice Address - Street 1:943 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3508
Practice Address - Country:US
Practice Address - Phone:509-943-1211
Practice Address - Fax:509-946-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030600261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104041Medicaid