Healthcare Provider Details

I. General information

NPI: 1710240924
Provider Name (Legal Business Name): WHITMAN COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 SE PROFESSIONAL MALL BLVD SUITE 203
PULLMAN WA
99163-5423
US

IV. Provider business mailing address

310 N MAIN ST SUITE 108
COLFAX WA
99111-1848
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-6752
  • Fax: 509-334-4517
Mailing address:
  • Phone: 509-397-6280
  • Fax: 509-397-6239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5901152
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier7401433
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 3
Identifier5901145
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier7071137
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 5
Identifier5901467
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: MRS. FRAN MARTIN
Title or Position: DEPARTMENT HEAD
Credential: RN
Phone: 509-397-6280