Provider Demographics
NPI:1164580700
Name:OKANOGAN COUNTY PUBLIC HOSPITAL DIST NO 4
Entity Type:Organization
Organization Name:OKANOGAN COUNTY PUBLIC HOSPITAL DIST NO 4
Other - Org Name:NORTH VALLEY HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
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 1:203 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-8803
Practice Address - Country:US
Practice Address - Phone:509-486-2151
Practice Address - Fax:509-486-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
WAH-107282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH-107OtherWASHINGTON STATE DOH LICENSE
030OtherBLUE CROSS
WA3318201Medicaid
WA13751OtherL & I
WA3318201Medicaid
WA501321Medicare Oscar/Certification