Provider Demographics
NPI:1043549496
Name:SK WADHWA, M.D., FACC,P.S.
Entity type:Organization
Organization Name:SK WADHWA, M.D., FACC,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURENDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-3185
Mailing Address - Street 1:217 TORBETT STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-943-3185
Mailing Address - Fax:509-946-8012
Practice Address - Street 1:217 TORBETT STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-943-3185
Practice Address - Fax:509-946-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016812261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107168Medicaid
WA1107168Medicaid