Healthcare Provider Details

I. General information

NPI: 1760466114
Provider Name (Legal Business Name): WALLA WALLA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S 2ND AVE
WALLA WALLA WA
99362-4116
US

IV. Provider business mailing address

PO BOX 1398
WALLA WALLA WA
99362-0309
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-0480
  • Fax: 509-527-8159
Mailing address:
  • Phone: 509-525-0480
  • Fax: 509-527-8159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHAC.FS.00000043
License Number StateWA

VIII. Authorized Official

Name: MR. RICK D BOCKMANN
Title or Position: CEO
Credential:
Phone: 509-525-0480