Provider Demographics
NPI:1437631959
Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity Type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Other - Org Name:ELLENSBURG PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LITTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-7424
Mailing Address - Street 1:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-1921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3692
Practice Address - Country:US
Practice Address - Phone:509-962-5437
Practice Address - Fax:509-962-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty