NPIMap

Organization Active NPI

Mid-Columbia Endoscopy Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Kennewick, WA
National Provider Identifier
1184926834
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MID-COLUMBIA ENDOSCOPY CENTER, LLC
Practice address
8819 W Victoria Ave
Kennewick, WA 99336-7193
Phone
(509) 460-5500
NPI assigned
Dec 1, 2010
Last updated
Mar 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Somprak Boonpongmanee, MDNPI 1528139359
Title
Owner
Phone
(509) 460-5500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

8819 W Victoria Ave
Kennewick, WA 99336-7193

Mailing address

8819 W Victoria Ave
Kennewick, WA 99336-7193
Phone (509) 460-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110316000429 WA Part B Supplier - Ambulatory Surgical Center 5092997700 Receives reassigned benefits from 1 practitioner
Practice locations: Kennewick, WA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Mid Columbia Endoscopy Center LLCCCN 50C0001087
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

8819 W Victoria Ave
Kennewick, WA 99336
Phone (509) 460-5500

8819 W Victoria Ave
Ste 130
Kennewick, WA 99336
Phone (509) 460-5500

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743379200000",
    "number": "1184926834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8819 W VICTORIA AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367193",
            "telephone_number": "509-460-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8819 W VICTORIA AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367193",
            "telephone_number": "509-460-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-COLUMBIA ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-01",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "BOONPONGMANEE",
        "authorized_official_first_name": "SOMPRAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-460-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.