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General NPI Number Information
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NPI Number | 1841574241
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Entity Type | Organization
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Legal Business Name | COLUMBIA BASIN HEALTH ASSOCIATION
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 1051 S COLUMBIA AVE
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City | CONNELL
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State | WA
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Zip | 99326-8702
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Country | US
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Telephone | 509-234-0866
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Fax | 509-488-9939
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Provider Business Mailing Address
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Address Line | 1515 E COLUMBIA ST
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City | OTHELLO
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State | WA
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Zip | 99344-1846
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Country | US
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Telephone | 509-488-5256
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Fax | 509-488-9939
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Authorized Official
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Title or Position | CEO
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Name | NIEVES GOMEZ
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Credential |
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Telephone | 509-488-5256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | WA
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