=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750268736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF GRANT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2025
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 C ST NW
-----------------------------------------------------
City | EPHRATA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98823-1685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-237-4589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 C ST NW
-----------------------------------------------------
City | EPHRATA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98823-1685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-237-4589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF DEPUTY
-----------------------------------------------------
Name | PHILLIP COATS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-754-2011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2400X
-----------------------------------------------------
Taxonomy Name | Prison Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------