Provider Demographics
NPI:1437199072
Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Entity Type:Organization
Organization Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Other - Org Name:BENTON CITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-786-2222
Mailing Address - Street 1:723 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1524
Mailing Address - Country:US
Mailing Address - Phone:509-786-2222
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:701 DALE AVE
Practice Address - Street 2:
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320-5250
Practice Address - Country:US
Practice Address - Phone:509-588-4075
Practice Address - Fax:509-588-4197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000056261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7600067Medicaid
WA7016165Medicaid
WA7064801Medicaid
WA0016909OtherBCC L & I #
WA0016909OtherBCC L & I #
WA7016165Medicaid