NPIMap

Organization Active NPI

Memorial Practice Management, LLC

  • Multi-Specialty Clinic/Center
  • Yakima, WA
National Provider Identifier
1194967562
Registry record updated Apr 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MEMORIAL PRACTICE MANAGEMENT, LLC
Practice address
402 S 12TH Ave
Yakima, WA 98902-3115
Phone
(509) 248-3263
Fax
(509) 573-3818
NPI assigned
Apr 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2009

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

Authorized official

Name
Jim W Simmons
Title
Chief Financial Officer
Phone
(509) 248-7849

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X WA Primary

Addresses

Primary practice location

402 S 12TH Ave
Yakima, WA 98902-3115

Mailing address

PO Box 2947
Yakima, WA 98907-2947
Phone (509) 248-7849

Other identifiers 1

IdentifierTypeStateIssuer
7056922MedicaidWA

Other names 1

  • Cornerstone Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Memorial Practice Management LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238544000000",
    "number": "1194967562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2947",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989072947",
            "telephone_number": "509-248-7849",
            "fax_number": "509-248-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S 12TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023115",
            "telephone_number": "509-248-3263",
            "fax_number": "509-573-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL PRACTICE MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-01",
        "last_updated": "2009-04-01",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "509-248-7849"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7056922",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.