Provider Demographics
NPI:1497205439
Name:LINCOLN COUNTY HOSPITAL DISTRICT #3 / NORTH BASIN MEDICAL CLINICS
Entity Type:Organization
Organization Name:LINCOLN COUNTY HOSPITAL DISTRICT #3 / NORTH BASIN MEDICAL CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:509-725-9912
Mailing Address - Street 1:100 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-5008
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:100 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-5008
Practice Address - Country:US
Practice Address - Phone:509-725-7501
Practice Address - Fax:509-725-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117435OtherNORTH BASIN MEDICAL REARDAN CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA7117443OtherNORTH BASIN MEDICAL WILBUR CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA7117450OtherNORTH BASIN MEDICAL DAVENPORT CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA501305Medicare Oscar/Certification
WA7117450OtherNORTH BASIN MEDICAL DAVENPORT CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA7117443OtherNORTH BASIN MEDICAL WILBUR CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA7117435OtherNORTH BASIN MEDICAL REARDAN CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA508530Medicare Oscar/Certification
WA508529Medicare Oscar/Certification