Healthcare Provider Details

I. General information

NPI: 1528703485
Provider Name (Legal Business Name): COLUMBIA BASIN HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E COLUMBIA ST
OTHELLO WA
99344-1846
US

IV. Provider business mailing address

1515 E COLUMBIA ST
OTHELLO WA
99344-1846
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-5256
  • Fax: 509-488-9939
Mailing address:
  • Phone: 509-488-5256
  • Fax: 509-488-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. NIEVES GOMEZ
Title or Position: CEO
Credential:
Phone: 509-488-5256