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General NPI Number Information
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NPI Number | 1598814352
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Entity Type | Organization
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Legal Business Name | TRI-STATE MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 1221 HIGHLAND AVE
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City | CLARKSTON
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State | WA
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Zip | 99403-2829
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Country | US
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Telephone | 509-758-5511
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Fax | 509-751-9406
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Provider Business Mailing Address
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Address Line | 1221 HIGHLAND AVE
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City | CLARKSTON
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State | WA
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Zip | 99403-2829
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Country | US
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Telephone | 509-758-5511
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Fax | 509-751-9406
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Authorized Official
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Title or Position | CFO
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Name | ALEX C TOWN
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Credential |
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Telephone | 509-758-4667
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | H-108
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License Number State | WA
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