1184797433 NPI number — KENNEWICK PUBLIC HOSPITAL DISTRICT

Table of content: (NPI 1184797433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184797433 NPI number — KENNEWICK PUBLIC HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEWICK PUBLIC HOSPITAL DISTRICT
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:
KENNEWICK GENERAL HOSPITAL HOME HEALTH CARE
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:
1184797433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 N AUBURN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-3807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-582-2273
Provider Business Mailing Address Fax Number:
509-586-5102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 N AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-582-2273
Provider Business Practice Location Address Fax Number:
509-586-5102
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FULFS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
509-582-2273

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  MTS-2700 , 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: 9003146 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0087974 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 611184000 . This is a "DOL OWCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9006321 . This is a "DME" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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