1760455687 NPI number — PUBLIC HOSPITAL DISTRICT NO. 2, KLICKITAT COUNTY, WASHINGTON

Table of content: (NPI 1760455687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760455687 NPI number — PUBLIC HOSPITAL DISTRICT NO. 2, KLICKITAT COUNTY, WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HOSPITAL DISTRICT NO. 2, KLICKITAT COUNTY, WASHINGTON
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:
1760455687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE SALMON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98672-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-493-1101
Provider Business Mailing Address Fax Number:
509-493-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 SKYLINE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SALMON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98672-0099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-493-1101
Provider Business Practice Location Address Fax Number:
509-493-2838
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIMMES
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
509-637-2919

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  H-096 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8117327 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SK6515 . This is a "REGENCE OP #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9162306 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SK0315 . This is a "REGENCE IP #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 184713 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9060SK . This is a "REGENCE AMB #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3300209 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3620705 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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