| Organization Name: | YAKIMA VALLEY PROFESSIONAL SERVICES ON TIETON, PC |
| NPI Number: | 1972517704 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JIM SIMMONS (DIRECTOR OF FINANCE) |
| Mailing Address: | 202 W Naches Ave Selah |
| State: | WA US |
| Postal Code: | 989421326 |
| Phone Number: | 5096975511 |
| Fax Number: | 5096979313 |
| NPI Enumeration Date: | 07/28/2006 |
| NPI Last Update Date: | 12/31/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |