1134164692 NPI number — LEWIS COUNTY COMMUNITY HEALTH SERVICES

Table of content: (NPI 1134164692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134164692 NPI number — LEWIS COUNTY COMMUNITY HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS COUNTY COMMUNITY HEALTH SERVICES
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:
VALLEY VIEW HEALTH CENTER
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:
1134164692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2690 NE KRESKY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEHALIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98532-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-330-9595
Provider Business Mailing Address Fax Number:
360-330-9560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2690 NE KRESKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-330-9595
Provider Business Practice Location Address Fax Number:
360-330-9560
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPRADLEY
Authorized Official First Name:
GAELON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
360-330-9555

Provider Taxonomy Codes

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

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

  • Identifier: A001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A001 . This is a "CHAMPVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0208250 . This is a "DEPARTMENT OF L&I" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7126972 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8801670 . This is a "MEDICARE GROUP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9749VA . This is a "REGENCE BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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