1134283930 NPI number — GRANT COUNTY PUBLIC HOSPITAL DISTRICT 3

Table of content: (NPI 1134283930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134283930 NPI number — GRANT COUNTY PUBLIC HOSPITAL DISTRICT 3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANT COUNTY PUBLIC HOSPITAL DISTRICT 3
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:
1134283930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NAT WASHINGTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98823-1973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-754-4631
Provider Business Mailing Address Fax Number:
509-754-6356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NAT WASHINGTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-1973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-4631
Provider Business Practice Location Address Fax Number:
509-754-6356
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIBBY
Authorized Official First Name:
ROSALINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
509-754-4631

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , 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: 7143100 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7019466 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C03353 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CO0548 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002036 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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