Provider Demographics
NPI:1477088391
Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Entity Type:Organization
Organization Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Other - Org Name:PROSSER CLINIC-PROSSER MEMORIAL HEALTH
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 1:336 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:509-786-1576
Practice Address - Fax:509-786-1574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-28
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care