Healthcare Provider Details

I. General information

NPI: 1053369074
Provider Name (Legal Business Name): COLUMBIA CAPITAL MEDICAL CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W. MAIN ST.
ELMA WA
98541-9551
US

IV. Provider business mailing address

515 W. MAIN ST.
ELMA WA
98541-9551
US

V. Phone/Fax

Practice location:
  • Phone: 360-956-6354
  • Fax: 360-482-5157
Mailing address:
  • Phone: 360-956-3541
  • Fax: 360-482-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH-197
License Number StateWA

VIII. Authorized Official

Name: SHELDON RAY COFFEY
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 615-764-3009