Provider Demographics
NPI:1932354909
Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CBO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-933-8771
Mailing Address - Street 1:P.O. BOX 799
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-962-9841
Mailing Address - Fax:509-925-8486
Practice Address - Street 1:700 E MANITOBA AVE STE 101
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3885
Practice Address - Country:US
Practice Address - Phone:509-962-9841
Practice Address - Fax:509-962-7351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-18
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH 140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty