Provider Demographics
NPI:1215487210
Name:KITTITAS COUNTY PUBLIC HOSP DIST 1
Entity type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSP DIST 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-7301
Mailing Address - Street 1:603 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3875
Mailing Address - Country:US
Mailing Address - Phone:509-925-8484
Mailing Address - Fax:509-925-8485
Practice Address - Street 1:603 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3875
Practice Address - Country:US
Practice Address - Phone:509-925-8484
Practice Address - Fax:509-925-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.605882033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165866OtherPK