1376561654 NPI number — KITTITAS COUNTY PUBLIC HOSPITAL DIST 1

Table of content: CAROL LOUISE SIKORSKI WHNP (NPI 1528109410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376561654 NPI number — KITTITAS COUNTY PUBLIC HOSPITAL DIST 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
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:
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:
1376561654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLENSBURG
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-962-7438
Provider Business Mailing Address Fax Number:
509-925-8450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 E MOUNTAIN VIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-8499
Provider Business Practice Location Address Fax Number:
509-925-8450
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPRAGUE
Authorized Official First Name:
AGGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER TRANSITIONAL CARE HOME HEAL
Authorized Official Telephone Number:
509-962-7438

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IS-320 , 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: 009490004 . This is a "GROUP HEALTH COOPERATIVE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 44265 . This is a "ST OF WA LABOT & INDUSTRI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9036823 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152 . This is a "BLUE CROSS OF WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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