Provider Demographics
NPI:1437261914
Name:EPHRATA MEDICAL CENTER P.S.
Entity Type:Organization
Organization Name:EPHRATA MEDICAL CENTER P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-754-3563
Mailing Address - Street 1:508 W DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1887
Mailing Address - Country:US
Mailing Address - Phone:509-754-3563
Mailing Address - Fax:509-754-5124
Practice Address - Street 1:508 W DIVISION AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1887
Practice Address - Country:US
Practice Address - Phone:509-754-3563
Practice Address - Fax:509-754-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019203261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7841000Medicaid
WA8457400Medicaid
WA0074400Medicare ID - Type Unspecified
WA074402Medicare ID - Type Unspecified
WA503861Medicare Oscar/Certification
WA7841000Medicaid