=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770711764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2009
-----------------------------------------------------
Last Update Date | 05/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E JACKSON AVE
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-3692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-933-8777
-----------------------------------------------------
Fax | 509-933-8741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 799
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-933-8771
-----------------------------------------------------
Fax | 509-933-8692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR REVENUE CYCLE
-----------------------------------------------------
Name | MS. BECKY LITTKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-962-7424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | H-140
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------