1568719359 NPI number — YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION

Table of content: (NPI 1568719359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568719359 NPI number — YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION
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:
6
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:
1568719359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4003 WEST CREEKSIDE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-573-3808
Provider Business Mailing Address Fax Number:
509-573-3809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4003 CREEKSIDE LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-573-3808
Provider Business Practice Location Address Fax Number:
509-573-3809
Provider Enumeration Date:
08/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BUYOK
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-575-8001

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHAR.CF.60509437 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHAR.CF.60509437 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: PHAR.CF.60509437 , 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: 2023584 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4934774 . This is a "NCPDP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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