Provider Demographics
NPI:1134280811
Name:OKANOGAN COUNTY PUBLIC HOSPITAL DISTRICT NO 4
Entity Type:Organization
Organization Name:OKANOGAN COUNTY PUBLIC HOSPITAL DISTRICT NO 4
Other - Org Name:OROVILLE FAMILY MEDICAL CLINIC - RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCREYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-486-3128
Mailing Address - Street 1:203 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-8803
Mailing Address - Country:US
Mailing Address - Phone:509-486-2151
Mailing Address - Fax:509-486-3116
Practice Address - Street 1:1617 MAIN ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:WA
Practice Address - Zip Code:98844-9380
Practice Address - Country:US
Practice Address - Phone:509-476-3911
Practice Address - Fax:509-486-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-107261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA030OtherBLUE CROSS
WA7114135Medicaid
WA78590OtherL & I
WA7114135Medicaid