Provider Demographics
NPI:1376894048
Name:WALLA WALLA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WALLA WALLA GENERAL HOSPITAL
Other - Org Name:ADVENTIST HEALTH MEDICAL GROUP PROSSER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-0480
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0309
Mailing Address - Country:US
Mailing Address - Phone:509-522-0100
Mailing Address - Fax:509-527-8010
Practice Address - Street 1:336 CHARDONNAY AVE STE A
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350
Practice Address - Country:US
Practice Address - Phone:509-786-2002
Practice Address - Fax:509-786-2026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALLA WALLA GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-21
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363006281261Q00000X, 261QM1300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health