MEDICARE: PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	247100000X	Radiologic Technologist
3	261QC0050X	Critical Access Hospital Clinic/Center
4	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician
5	291U00000X	Clinical Medical Laboratory
6	282NC0060X	Critical Access Hospital	H-172	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	82105	OTHER	WA	LABOR & IND. (PHYS GROUP)
5	077	OTHER	WA	PREMERA BLUE CROSS
6	2590	OTHER	WA	LABOR & INDUSTRIES (FAC)
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366446767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY

Provider Business Mailing Address
First Line	:	835 SE BISHOP BLVD
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5512
Country	:	US
Telephone Number	:	509-332-2514
Fax Number	:	509-336-7642

Provider Business Practice Location Address
First Line	:	835 SE BISHOP BLVD
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5512
Country	:	US
Telephone Number	:	509-332-2514
Fax Number	:	509-332-0731

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MATT FORGE
Credential	:	CEO
Telephone Number	:	509-336-7300

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/22/2025

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