Provider Demographics
NPI:1558398230
Name:OKANOGAN COUNTY PUBLIC HOSPITAL DISTRICT NO. 3
Entity Type:Organization
Organization Name:OKANOGAN COUNTY PUBLIC HOSPITAL DISTRICT NO. 3
Other - Org Name:MID-VALLEY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-826-1760
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0793
Mailing Address - Country:US
Mailing Address - Phone:509-826-1600
Mailing Address - Fax:509-826-3633
Practice Address - Street 1:529 JASMINE ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9589
Practice Address - Country:US
Practice Address - Phone:509-826-1600
Practice Address - Fax:509-826-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013242Medicaid
WA7121411Medicaid
WA7119647Medicaid
WA7590805Medicaid
WA0176652Medicaid
WA7590805Medicaid
WA0930470001Medicare NSC