Basic Information
Provider Information | |||||||||
NPI: | 1124438312 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHELAN COUNTY PUBLIC HOSPITAL DISTRICT NO 2 | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | LAKE CHELAN COMMUNITY HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 503 E HIGHLAND AVE | ||||||||
Address2: |   | ||||||||
City: | CHELAN | ||||||||
State: | WA | ||||||||
PostalCode: | 988168631 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5096823300 | ||||||||
FaxNumber: | 5096829614 | ||||||||
Practice Location | |||||||||
Address1: | 503 E HIGHLAND AVE | ||||||||
Address2: |   | ||||||||
City: | CHELAN | ||||||||
State: | WA | ||||||||
PostalCode: | 988168631 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5096823300 | ||||||||
FaxNumber: | 5096829614 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/28/2014 | ||||||||
LastUpdateDate: | 09/26/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ABEL | ||||||||
AuthorizedOfficialFirstName: | KEVIN | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 5096823300 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC0050X | 600071822 | WA | N |   | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital | 261QR1300X | 600071822 | WA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.