1497752646 NPI number — BENTON FRANKLIN DISTRICT HEALTH DEPARTMENT

Table of content: (NPI 1497752646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497752646 NPI number — BENTON FRANKLIN DISTRICT HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENTON FRANKLIN DISTRICT HEALTH DEPARTMENT
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:
BENTON FRANKLIN HEALTH DISTRICT
Provider Other Organization Name Type Code:
5
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:
1497752646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7102 W OKANOGAN PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-460-4200
Provider Business Mailing Address Fax Number:
509-460-4590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7102 W OKANOGAN PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-460-4200
Provider Business Practice Location Address Fax Number:
509-460-4590
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZACCARIA
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH DISTRICT ADMINISTRATOR
Authorized Official Telephone Number:
509-460-4567

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5900717 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7246903 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7403652 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0087617 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7400823 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7400187 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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