1972721710 NPI number — COLUMBIA BASIN HEALTH ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972721710 NPI number — COLUMBIA BASIN HEALTH ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA BASIN HEALTH 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:
1972721710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 E COLUMBIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTHELLO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99344-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-488-5256
Provider Business Mailing Address Fax Number:
509-488-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 N 14TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTHELLO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99344-1226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-488-6644
Provider Business Practice Location Address Fax Number:
509-488-9939
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
NIEVES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
509-488-5256

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , 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: 50D0640014 . This is a "CLIA #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7121585 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08908941 . This is a "CRIME VICTIMS #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7406119 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7900624 . This is a "TAKE CHARGE #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0035900 . This is a "DEPT L&I #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7107675 . This is a "UGS MDC DSHS CROSSOVER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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