Healthcare Provider Details

I. General information

NPI: 1295071520
Provider Name (Legal Business Name): WENATCHEE VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

IV. Provider business mailing address

PO BOX 361
WENATCHEE WA
98807-0361
US

V. Phone/Fax

Practice location:
  • Phone: 509-663-8711
  • Fax: 509-664-7178
Mailing address:
  • Phone: 509-663-8711
  • Fax: 509-664-7178

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 TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier300449
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: MR. GLENN ADAMS
Title or Position: COO
Credential:
Phone: 509-663-8711