Provider Demographics
NPI:1558828467
Name:PUBLIC HOSPITAL DISTRICT 1 OF KLICKITAT CO
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT 1 OF KLICKITAT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-773-1002
Mailing Address - Street 1:310 S ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620
Mailing Address - Country:US
Mailing Address - Phone:509-773-4022
Mailing Address - Fax:509-773-1036
Practice Address - Street 1:310 S ROOSEVELT
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620
Practice Address - Country:US
Practice Address - Phone:509-773-4022
Practice Address - Fax:509-773-1036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HOSPITAL DISTRICT 1 OF KLICKITAT CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy