Provider Demographics
NPI:1497752646
Name:BENTON FRANKLIN DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BENTON FRANKLIN DISTRICT HEALTH DEPARTMENT
Other - Org Name:BENTON FRANKLIN HEALTH DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACCARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:509-460-4567
Mailing Address - Street 1:7102 W OKANOGAN PLACE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-460-4200
Mailing Address - Fax:509-460-4590
Practice Address - Street 1:7102 W OKANOGAN PLACE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-460-4200
Practice Address - Fax:509-460-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5900717Medicaid
WA7246903Medicaid
WA7403652Medicaid
WA0087617OtherLABOR & INDUSTRY
WA7400823Medicaid
WA7400187Medicaid
WA7246903Medicaid
WAGAB33791Medicare PIN