Healthcare Provider Details

I. General information

NPI: 1164461455
Provider Name (Legal Business Name): YAKIMA HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W 4TH AVE
TOPPENISH WA
98948-1616
US

IV. Provider business mailing address

502 W 4TH AVE
TOPPENISH WA
98948-1616
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-1520
  • Fax:
Mailing address:
  • Phone: 509-865-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-465-7466