1710240924 NPI number — WHITMAN COUNTY HEALTH DEPARTMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710240924 NPI number — WHITMAN COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITMAN COUNTY HEALTH DEPARTMENT
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:
1710240924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 N MAIN ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
COLFAX
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99111-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-397-6280
Provider Business Mailing Address Fax Number:
509-397-6239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 SE PROFESSIONAL MALL 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:
99163-5423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-6752
Provider Business Practice Location Address Fax Number:
509-334-4517
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
FRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPARTMENT HEAD
Authorized Official Telephone Number:
509-397-6280

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5901152 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7401433 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5901145 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7071137 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5901467 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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