Healthcare Provider Details

I. General information

NPI: 1750443834
Provider Name (Legal Business Name): OKANOGAN COUNTY PUBLIC HOSPITAL DIST NO 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WESTERN AVE
TONASKET WA
98855-8803
US

IV. Provider business mailing address

203 S WESTERN AVE
TONASKET WA
98855-8803
US

V. Phone/Fax

Practice location:
  • Phone: 509-486-2151
  • Fax: 509-486-3116
Mailing address:
  • Phone: 509-486-2151
  • Fax: 509-486-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberH-107
License Number StateWA

VIII. Authorized Official

Name: MR. JOHN MCREYNOLDS
Title or Position: CEO
Credential:
Phone: 509-486-3128