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General NPI Number Information
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NPI Number | 1508924275
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Entity Type | Organization
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Legal Business Name | KITTITAS COUNTY PUBLIC HEALTH
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 507 N NANUM ST SUITE 102
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City | ELLENSBURG
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State | WA
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Zip | 98926
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Country | US
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Telephone | 509-962-7515
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Fax | 509-962-7581
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Provider Business Mailing Address
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Address Line | 507 N NANUM ST SUITE 102
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City | ELLENSBURG
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State | WA
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Zip | 98926
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Country | US
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Telephone | 509-962-7515
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Fax | 509-962-7581
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Authorized Official
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Title or Position | HEALTH OFFICER
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Name | DR. MARK LARSON
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Credential | MD
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Telephone | 509-962-7515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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