GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5 NPI 1699720797

NPI Information

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
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GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5 is a federally qualified health center (fqhc) clinic center 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 12/16/2019.

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 State	Primary
1	207Q00000X	Family Medicine			No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	WASHINGTON	Yes
3	363L00000X	Nurse Practitioner			No

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
1	501944	OTHER	WASHINGTON	MEDICARE PTAN
2	7044167	MEDICAID	WASHINGTON
3	7035611	OTHER	WASHINGTON	DSHS FEE FOR SERVICE
4	7406572	OTHER	WASHINGTON	DSHS MSS
5	67850	OTHER	WASHINGTON	LABOR & INDUSTRIES
6	7900657	OTHER	WASHINGTON	DSHS TAKE CHARGE

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: 11/14/2023

NPI Synchronization or Removal

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