1568678258 NPI number — MOSES LAKE COMMUNITY HEALTH CENTER

Table of content: (NPI 1568678258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568678258 NPI number — MOSES LAKE COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSES LAKE COMMUNITY HEALTH CENTER
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:
Provider Other Organization Name Type Code:
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:
1568678258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 S COOLIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSES LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98837-1893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-765-0674
Provider Business Mailing Address Fax Number:
509-765-6591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 S COOLIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSES LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98837-1893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-765-0674
Provider Business Practice Location Address Fax Number:
509-765-6591
Provider Enumeration Date:
05/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHILSON
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
509-765-0674

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7406101 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".