Basic Information
| Provider Information | |||||||||
| NPI: | 1114028693 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | POMEROY MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | POMEROY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993479705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098431491 | ||||||||
| FaxNumber: | 5098431740 | ||||||||
| Practice Location | |||||||||
| Address1: | 446 PATAHA ST | ||||||||
| Address2: | |||||||||
| City: | POMEROY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993478634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098431491 | ||||||||
| FaxNumber: | 5098431740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/25/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PARNELL | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/SUPERINTENDENT | ||||||||
| AuthorizedOfficialTelephone: | 5098431591 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GARFIELD COUNTY PUBLIC HOSPITAL DISTRICT #1 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 503982 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 7105463 | 01 | WA | MEDICA RURAL HEALTH ENCO | OTHER | 7023161 | 05 | WA | MEDICAID |