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NPI Code Detail

MEDICARE: TRI-STATE MEMORIAL HOSPITAL

MEDICARE: TRI-STATE MEMORIAL HOSPITAL
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
1282NC0060XCritical Access HospitalH-108WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000010002128OTHERREGENCE BLUE SHIELD OF IDAHO
400620OTHERBLUE CROSS OF IDAHO

General Provider Information

NPI Number : 1760485221
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI-STATE MEMORIAL HOSPITAL
Provider Business Mailing Address
First Line : 1221 HIGHLAND AVE
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2829
Country : US
Telephone Number : 509-758-5511
Fax Number : 509-751-9406
Provider Business Practice Location Address
First Line : 1221 HIGHLAND AVE
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2829
Country : US
Telephone Number : 509-758-5511
Fax Number : 509-751-9406
Authorized Official
Title or Position : CFO
Name : MR. ALEX C TOWN
Credential :
Telephone Number : 509-758-4667
Provider Enumeration Date : 05/27/2005
Last Update Date : 03/24/2011

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Directions to “TRI-STATE MEMORIAL HOSPITAL ” Practice Location

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