1891821013 NPI number — YAKIMA VALLEY FARM WORKERS CLINIC

Table of content: NICHOLAS JOHN WHALEN DO (NPI 1174144489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891821013 NPI number — YAKIMA VALLEY FARM WORKERS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKIMA VALLEY FARM WORKERS CLINIC
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:
1891821013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPPENISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98948-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-786-1931
Provider Business Mailing Address Fax Number:
509-786-1997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 MEMORIAL ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-786-1931
Provider Business Practice Location Address Fax Number:
509-786-1997
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TROTTER
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
509-865-6175

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41000 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: YA0023 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7106131 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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