Provider Demographics
NPI:1366446767
Name:PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT #1-A OF WHITMAN COUNTY
Other - Org Name:PULLMAN REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-336-7362
Mailing Address - Street 1:835 SE BISHOP BLVD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5512
Mailing Address - Country:US
Mailing Address - Phone:509-332-2514
Mailing Address - Fax:509-336-7642
Practice Address - Street 1:835 SE BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5512
Practice Address - Country:US
Practice Address - Phone:509-332-2514
Practice Address - Fax:509-332-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PE0004X, 247100000X, 261QC0050X, 261QU0200X, 291U00000X
WAH-172282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003221800Medicaid
WA3303708Medicaid
ID003221990Medicaid
WA82105OtherLABOR & IND. (PHYS GROUP)
WA077OtherPREMERA BLUE CROSS
WA2590OtherLABOR & INDUSTRIES (FAC)
WA7030661Medicaid
WA3303708Medicaid
WA501331Medicare Oscar/Certification