Healthcare Provider Details

I. General information

NPI: 1326113366
Provider Name (Legal Business Name): PEND OREILLE COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W PINE ST
NEWPORT WA
99156-9046
US

IV. Provider business mailing address

714 W PINE ST
NEWPORT WA
99156-9046
US

V. Phone/Fax

Practice location:
  • Phone: 509-447-2441
  • Fax:
Mailing address:
  • Phone: 509-447-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH-021
License Number StateWA

VIII. Authorized Official

Name: KIM M MANUS
Title or Position: CEO
Credential:
Phone: 509-447-9310