Provider Demographics
NPI:1992958771
Name:WALLA WALLA GENERAL HOSPITAL
Entity type:Organization
Organization Name:WALLA WALLA GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOCKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-527-8000
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0309
Mailing Address - Country:US
Mailing Address - Phone:509-522-0100
Mailing Address - Fax:509-527-8010
Practice Address - Street 1:1111 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4118
Practice Address - Country:US
Practice Address - Phone:509-522-0100
Practice Address - Fax:509-527-8010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALLA WALLA GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-24
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363006281261Q00000X
261QM1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7112170OtherRHC
WA508550Medicare Oscar/Certification
WA7112170OtherRHC
WA508550Medicare Oscar/Certification