1386774222 NPI number — GARFIELD COUNTY HEALTH DISTRICT

Table of content: (NPI 1386774222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386774222 NPI number — GARFIELD COUNTY HEALTH DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARFIELD COUNTY HEALTH 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:
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:
1386774222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMEROY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99347-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-843-3412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 SOUTH 10TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMEROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-843-3412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRAVIS
Authorized Official First Name:
LETA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
509-843-3412

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  MD00025084 , 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: 7405806 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5044011 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7034739 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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