Healthcare Provider Details

I. General information

NPI: 1356375307
Provider Name (Legal Business Name): KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S. CHESTNUT ST
ELLENSBURG WA
98926
US

IV. Provider business mailing address

P.O. BOX 799
ELLENSBURG WA
98926
US

V. Phone/Fax

Practice location:
  • Phone: 509-962-9841
  • Fax: 509-962-7351
Mailing address:
  • Phone: 509-962-9841
  • Fax: 509-925-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-140
License Number StateWA

VIII. Authorized Official

Name: BECKY L LITTKE
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 509-962-7424