Basic Information
| Provider Information | |||||||||
| NPI: | 1922009448 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PUBLIC HOSPITAL DISTRICT NO 3 OF WHITMAN COUNTY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WHITMAN HOSPITAL & MEDICAL CLINICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 W FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | COLFAX | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991119552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093973435 | ||||||||
| FaxNumber: | 5093974713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 W FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | COLFAX | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991119552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093973435 | ||||||||
| FaxNumber: | 5093974713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | ABBY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5093975755 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 3365202 | 05 | WA | MEDICAID |