Provider Demographics
NPI:1487679262
Name:KITTITAS COUNTY PUBLIC HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSPITAL DISTRICT
Other - Org Name:KITTITAS VALLEY COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-7312
Mailing Address - Street 1:603 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3875
Mailing Address - Country:US
Mailing Address - Phone:509-962-9841
Mailing Address - Fax:509-962-7351
Practice Address - Street 1:603 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926
Practice Address - Country:US
Practice Address - Phone:509-962-9841
Practice Address - Fax:509-962-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-140282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0007775OtherST OF WASH LABOR & INDUST
WA835OtherGROUP HEALTH COOPERATIVE
WA9625476Medicaid
WA7994304Medicaid
WA152OtherBLUE CROSS-ER PHY/GNP
WA7994304Medicaid
WA152OtherBLUE CROSS-ER PHY/GNP