Healthcare Provider Details

I. General information

NPI: 1194747774
Provider Name (Legal Business Name): KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ALPHA WAY
CLE ELUM WA
98922-1045
US

IV. Provider business mailing address

P.O. BOX 799
ELLENSBURG WA
98926
US

V. Phone/Fax

Practice location:
  • Phone: 509-674-5331
  • Fax: 509-674-5034
Mailing address:
  • Phone: 509-962-5060
  • Fax: 509-674-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEAN ROBERSON
Title or Position: DIRECTOR CBO
Credential:
Phone: 509-933-8771