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General NPI Number Information
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NPI Number | 1568575504
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Entity Type | Organization
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Legal Business Name | ELKHORN VALLEY CORPORATION
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 E MOUNTAIN VIEW AVE
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City | ELLENSBURG
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State | WA
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Zip | 98926-5312
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Country | US
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Telephone | 509-962-6348
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Fax | 509-962-2003
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Provider Business Mailing Address
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Address Line | 107 E MOUNTAIN VIEW AVE
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City | ELLENSBURG
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State | WA
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Zip | 98926-5312
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Country | US
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Telephone | 509-962-6348
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Fax | 509-962-2003
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Authorized Official
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Title or Position | PRESIDENT
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Name | BYRON L HANEY
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Credential | M.D.
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Telephone | 509-962-6348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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