1376773002 NPI number — KITTIAS COUNTY PUBLIC HOSPITAL DIST 1

Table of content: UDAY B MANCHALA DDS (NPI 1093190662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376773002 NPI number — KITTIAS COUNTY PUBLIC HOSPITAL DIST 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KITTIAS COUNTY PUBLIC HOSPITAL DIST 1
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:
KVH WOMEN'S HEALTH
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:
1376773002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLENSBURG
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-933-8720
Provider Business Mailing Address Fax Number:
509-933-8722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E JACKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-5437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LITTKE
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
REVENUE CYCLE DIRECTOR
Authorized Official Telephone Number:
509-962-7424

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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