Provider Demographics
NPI:1003016825
Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity Type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Other - Org Name:KVH ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CBO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-933-8771
Mailing Address - Street 1:P.O. BOX 799
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-933-8700
Mailing Address - Fax:509-933-8705
Practice Address - Street 1:611 S CHESTNUT ST STE D
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-4815
Practice Address - Country:US
Practice Address - Phone:509-933-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty