Provider Demographics
NPI:1306933940
Name:YAKIMA VALLEY MEMORIAL PHYSICIANS
Entity type:Organization
Organization Name:YAKIMA VALLEY MEMORIAL PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PROVIDER DATA & ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-459-8009
Mailing Address - Street 1:PO BOX 9787
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909
Mailing Address - Country:US
Mailing Address - Phone:509-574-3353
Mailing Address - Fax:509-225-3168
Practice Address - Street 1:2811 TIETON DRIVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-575-8825
Practice Address - Fax:509-577-5056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAKIMA VALLEY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0025654OtherLABOR AND INDUSTRIES
WA7128648Medicaid
WA25654OtherLABOR AND INDUSTRIES #
WA7128648Medicaid
G8854969Medicare UPIN