Provider Demographics
NPI:1114028693
Name:GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:POMEROY MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-843-1591
Mailing Address - Street 1:66 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:WA
Mailing Address - Zip Code:99347-9705
Mailing Address - Country:US
Mailing Address - Phone:509-843-1491
Mailing Address - Fax:509-843-1740
Practice Address - Street 1:446 PATAHA ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:WA
Practice Address - Zip Code:99347-8634
Practice Address - Country:US
Practice Address - Phone:509-843-1491
Practice Address - Fax:509-843-1740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARFIELD COUNTY PUBLIC HOSPITAL DISTRICT #1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA503982261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7105463OtherMEDICA RURAL HEALTH ENCO
WA7023161Medicaid
WAG000341450Medicare UPIN
WA7105463OtherMEDICA RURAL HEALTH ENCO