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GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5 NPI 1699720797

NPI Profile

NPI: 1699720797
Provider Name: GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5

Doing Business As: MATTAWA COMMUNITY MEDICAL CLINIC

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
210 GOVERNMENT ROAD
MATTAWA, WA
ZIP 99349

Phone: (509) 932-4499

GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5 is a healthcare provider in Mattawa, WA. GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5 NPI is 1699720797. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Mattawa Community Medical Clinic.

The provider's business location address is:

210 GOVERNMENT ROAD
MATTAWA, WA
ZIP 99349-960
Phone: (509) 932-4499
Fax: (509) 932-5363

The provider's authorized official is Dana S Fox .
The authorized official title is Ceo/executive Director and has the following contact phone number (509) 932-4499.

The enumeration date for this NPI number is 5/24/2006 and was last updated on 11/4/2015.

Map - Location of Practice

Business Address

GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5
210 GOVERNMENT ROAD
MATTAWA, WA
ZIP 99349
Get Directions

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineNo
2363L00000XNurse PractitionerNo
3261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17035611OTHERWASHINGTONDSHS FEE FOR SERVICE
267850OTHERWASHINGTONLABOR & INDUSTRIES
3501944OTHERWASHINGTONMEDICARE PTAN
47900657OTHERWASHINGTONDSHS TAKE CHARGE
57044167MEDICAIDWASHINGTON
67406572OTHERWASHINGTONDSHS MSS
7503803MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 6/10/2018

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.