Provider Demographics
NPI:1306897681
Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Entity type:Organization
Organization Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-786-2222
Mailing Address - Street 1:PO BOX 84112
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5412
Mailing Address - Country:US
Mailing Address - Phone:509-786-2222
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:200 PROSSER HEALTH DR
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-7832
Practice Address - Country:US
Practice Address - Phone:509-786-2222
Practice Address - Fax:509-788-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000056261QC0050X, 282NC0060X
WAHAC.FS.00000046282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3303807Medicaid
WA7888803Medicaid
WA9048463Medicaid
WA0082383OtherL & I PROF/SERV
WA7064801Medicaid
WA001944OtherPMH L & I
WA7118334Medicaid
WA9048463Medicaid
WAG000301271Medicare PIN
WA7888803Medicaid
WA7064801Medicaid