1528399672 NPI number — PALOUSE PSYCHIATRY AND BEHAVIORAL HEALTH

Table of content: (NPI 1528399672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528399672 NPI number — PALOUSE PSYCHIATRY AND BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALOUSE PSYCHIATRY AND BEHAVIORAL HEALTH
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:
1528399672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 SE BISHOP BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PULLMAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99163-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-332-6139
Provider Business Mailing Address Fax Number:
509-332-6579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 SE BISHOP BLVD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-339-2394
Provider Business Practice Location Address Fax Number:
509-336-7484
Provider Enumeration Date:
01/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FEBUS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
509-332-6139

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , 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: G8891113 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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