1033259064 NPI number — COLUMBIA BASIN HEALTH ASSOCIATION

Table of content: (NPI 1033259064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033259064 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:
1033259064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
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:
601 GOVERNMENT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTAWA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-932-3535
Provider Business Practice Location Address Fax Number:
509-488-9939
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUNCH
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
509-488-5250

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  CF00056507 , 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: CF00056507 . This is a "STATE STORE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CF56507 . This is a "STATE CONTROLLED SBSTNC #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4927337 . This is a "NABP #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CH10046A . This is a "340B ID#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 135012 . This is a "DEPT L&I #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6022537 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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