Provider Demographics
NPI:1134283930
Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT 3
Entity Type:Organization
Organization Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT 3
Other - Org Name:COLUMBIA BASIN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-754-4631
Mailing Address - Street 1:200 NAT WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1973
Mailing Address - Country:US
Mailing Address - Phone:509-754-4631
Mailing Address - Fax:509-754-6356
Practice Address - Street 1:200 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1973
Practice Address - Country:US
Practice Address - Phone:509-754-4631
Practice Address - Fax:509-754-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7143100OtherDSHS
WA7019466Medicaid
WAC03353OtherMEDICARE RAILROAD
CO0548OtherREGENCE
WA0002036OtherL & I
WAC03353OtherMEDICARE RAILROAD
WA0002036OtherL & I
WA7143100OtherDSHS