1215023015 NPI number — ST MARY MEDICAL CENTER

Table of content: (NPI 1215023015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215023015 NPI number — ST MARY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST MARY MEDICAL CENTER
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:
1215023015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-522-5900
Provider Business Mailing Address Fax Number:
509-522-5578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 W POPLAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-5870
Provider Business Practice Location Address Fax Number:
509-522-5751
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARENTEAU
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
509-525-3320

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  H050 , 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: 800026 . This is a "MEDICAID" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 4212015 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 204884 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com