1073698437 NPI number — ST MARY MEDICAL CENTER

Table of content: (NPI 1073698437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073698437 NPI number — ST MARY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST MARY MEDICAL 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:
EMERGENCY DEPARTMENT
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:
1073698437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-522-5900
Provider Business Mailing Address Fax Number:
509-522-5578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 W POPLAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-5802
Provider Business Practice Location Address Fax Number:
509-522-5541
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLUMBER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE MANAGEMEN
Authorized Official Telephone Number:
509-522-5906

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  H-050 , 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: 25341 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 278204 . This is a "MEDICAID" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 7159205 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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