Healthcare Provider Details

I. General information

NPI: 1134177165
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: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 CAPITOL MALL DR SW
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

3900 CAPITOL MALL DR SW
OLYMPIA WA
98502-8654
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-5858
  • Fax: 360-956-2574
Mailing address:
  • Phone: 360-754-5858
  • Fax: 360-956-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH-197
License Number StateWA

VIII. Authorized Official

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