Basic Information
| Provider Information | |||||||||
| NPI: | 1750401006 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PULLMAN REGIONAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 518 | ||||||||
| Address2: | |||||||||
| City: | PULLMAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991630518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093367300 | ||||||||
| FaxNumber: | 5093320731 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 SE BISHOP BLVD | ||||||||
| Address2: | |||||||||
| City: | PULLMAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991635512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093367300 | ||||||||
| FaxNumber: | 5093320731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FEBUS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | DOUGLAS | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5093367362 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 000062 | WA | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 4200119 | 05 | WA | MEDICAID |