1255429957 NPI number — GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT

Table of content: (NPI 1255429957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255429957 NPI number — GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GARFIELD COUNTY PUBLIC HOSPITAL DISTRICT 1
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255429957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 NORTH 6TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMEROY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99347-9705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-566-4141
Provider Business Mailing Address Fax Number:
509-843-1234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 NORTH 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMEROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99347-9705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-566-4141
Provider Business Practice Location Address Fax Number:
509-843-1234
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARNELL
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/SUPERINTENDENT
Authorized Official Telephone Number:
509-566-4120

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3305406 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 501301 . This is a "MEDICARE UNSPECIFIED" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G000341450 . This is a "MEDICARE PART B" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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