1366446767 NPI number — PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY

Table of content: (NPI 1366446767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366446767 NPI number — PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY
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:
PULLMAN REGIONAL HOSPITAL
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:
1366446767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 SE BISHOP BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PULLMAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99163-5512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-332-2514
Provider Business Mailing Address Fax Number:
509-336-7642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 SE BISHOP BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-2514
Provider Business Practice Location Address Fax Number:
509-332-0731
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FEBUS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
509-336-7362

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: H-172 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003221800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3303708 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003221990 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82105 . This is a "LABOR & IND. (PHYS GROUP)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 077 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2590 . This is a "LABOR & INDUSTRIES (FAC)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7030661 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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