1639118490 NPI number — PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY

Table of content: (NPI 1639118490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639118490 NPI number — PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
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:
PROSSER MEMORIAL HOSPITAL HOME 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:
1639118490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
723 MEMORIAL STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSSER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99350-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-786-2222
Provider Business Mailing Address Fax Number:
509-786-6612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
723 MEMORIAL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-786-2222
Provider Business Practice Location Address Fax Number:
509-786-6612
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARKS
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
509-786-2222

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IS414 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: IHSFS.00000414 , 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: 100887 . This is a "L & I HOME HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 100888 . This is a "L & I HOME IV" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9040254 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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