Healthcare Provider Details

I. General information

NPI: 1366446767
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SE BISHOP BLVD
PULLMAN WA
99163-5512
US

IV. Provider business mailing address

835 SE BISHOP BLVD
PULLMAN WA
99163-5512
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2514
  • Fax: 509-332-0731
Mailing address:
  • Phone: 509-332-2514
  • Fax: 509-336-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-172
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MATT FORGE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 509-336-7300