Provider Demographics
NPI:1487736153
Name:COUNTY OF COLUMBIA
Entity type:Organization
Organization Name:COUNTY OF COLUMBIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-382-2181
Mailing Address - Street 1:1002 S 3RD STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328
Mailing Address - Country:US
Mailing Address - Phone:509-382-2181
Mailing Address - Fax:509-382-2942
Practice Address - Street 1:1002 S 3RD STREET
Practice Address - Street 2:STE 2
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328
Practice Address - Country:US
Practice Address - Phone:509-382-2181
Practice Address - Fax:509-382-2942
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF COLUMBIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6011447949251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5008065Medicaid
WA5901467Medicaid
AL7056518Medicaid
WA5040787Medicaid
WA7056518Medicare Oscar/Certification
WA5040787Medicaid
WA5008065Medicaid
WA5901467Medicare UPIN