Healthcare Provider Details

I. General information

NPI: 1134128911
Provider Name (Legal Business Name): COLUMBIA COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SOUTH THIRD STREET
DAYTON WA
99328
US

IV. Provider business mailing address

1012 SOUTH THIRD STREET
DAYTON WA
99328
US

V. Phone/Fax

Practice location:
  • Phone: 509-382-2531
  • Fax: 509-382-3205
Mailing address:
  • Phone: 509-382-2531
  • Fax: 509-382-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH141
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateWA

VIII. Authorized Official

Name: MR. MATT MINOR
Title or Position: CFO
Credential:
Phone: 509-382-2531