Basic Information
| Provider Information | |||||||||
| NPI: | 1306933940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAKIMA VALLEY MEMORIAL PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9787 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095743353 | ||||||||
| FaxNumber: | 5092253168 | ||||||||
| Practice Location | |||||||||
| Address1: | 2811 TIETON DRIVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095758825 | ||||||||
| FaxNumber: | 5095775056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCDONAGH | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5095758980 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | YAKIMA VALLEY MEMORIAL HOSPITAL | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0025654 | 01 | WA | LABOR AND INDUSTRIES | OTHER | 7128648 | 05 | WA | MEDICAID | 25654 | 01 | WA | LABOR AND INDUSTRIES # | OTHER |