Provider Demographics
NPI:1760455687
Name:PUBLIC HOSPITAL DISTRICT NO. 2, KLICKITAT COUNTY, WASHINGTON
Entity type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT NO. 2, KLICKITAT COUNTY, WASHINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-637-2919
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0099
Mailing Address - Country:US
Mailing Address - Phone:509-493-1101
Mailing Address - Fax:509-493-2838
Practice Address - Street 1:211 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-0099
Practice Address - Country:US
Practice Address - Phone:509-493-1101
Practice Address - Fax:509-493-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-096282NC0060X
WA341600000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8117327Medicaid
WASK6515OtherREGENCE OP #
WA9162306Medicaid
WASK0315OtherREGENCE IP #
OR184713Medicaid
WA9060SKOtherREGENCE AMB #
WA3300209Medicaid
WA3620705Medicaid
OR184713Medicaid
WA3300209Medicaid
WA50-1315Medicare PIN