1457414799 NPI number — GRANT CO PUBLIC HOSPITAL DISTRICT 3

Table of content: (NPI 1457414799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457414799 NPI number — GRANT CO PUBLIC HOSPITAL DISTRICT 3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANT CO PUBLIC HOSPITAL DISTRICT 3
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:
1457414799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 NAT WASHINGTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98823-1982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-754-3330
Provider Business Mailing Address Fax Number:
509-754-2351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 NAT WASHINGTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-1982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-3330
Provider Business Practice Location Address Fax Number:
509-754-2351
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIBBY
Authorized Official First Name:
ROSALINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ASSISTANT
Authorized Official Telephone Number:
509-754-4631

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 0073230 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8918013 . This is a "L & I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CO07813 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 503985 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CO0198 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7105331 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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