Healthcare Provider Details

I. General information

NPI: 1841574241
Provider Name (Legal Business Name): COLUMBIA BASIN HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 S COLUMBIA AVE
CONNELL WA
99326-8702
US

IV. Provider business mailing address

1515 E COLUMBIA ST
OTHELLO WA
99344-1846
US

V. Phone/Fax

Practice location:
  • Phone: 509-234-0866
  • Fax: 509-488-9939
Mailing address:
  • Phone: 509-488-5256
  • Fax: 509-488-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: NIEVES GOMEZ
Title or Position: CEO
Credential:
Phone: 509-488-5256