Provider Demographics
NPI:1235257262
Name:KENNEWICK PUBLIC HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:KENNEWICK PUBLIC HOSPITAL DISTRICT
Other - Org Name:KGH PHYSICIAN CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-586-6111
Mailing Address - Street 1:PO BOX 6128
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-0128
Mailing Address - Country:US
Mailing Address - Phone:509-737-1878
Mailing Address - Fax:509-737-1879
Practice Address - Street 1:900 S. AUBURN ST.
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-0128
Practice Address - Country:US
Practice Address - Phone:509-737-1880
Practice Address - Fax:509-737-1879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEWICK PUBLIC HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7137417Medicaid
WA3304003Medicaid
WA500053Medicare Oscar/Certification
WA7137417Medicaid