Provider Demographics
NPI:1467436030
Name:WALLA WALLA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WALLA WALLA GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:1025 S 2ND AVE
Mailing Address - Street 2:PO BOX 1398
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4116
Mailing Address - Country:US
Mailing Address - Phone:509-525-0480
Mailing Address - Fax:509-527-8195
Practice Address - Street 1:1025 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4116
Practice Address - Country:US
Practice Address - Phone:509-525-0480
Practice Address - Fax:509-527-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000091275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50U049Medicare ID - Type Unspecified