Provider Demographics
NPI:1568575504
Name:ELKHORN VALLEY CORPORATION
Entity Type:Organization
Organization Name:ELKHORN VALLEY CORPORATION
Other - Org Name:FAMILY HEALTH CARE OF ELLENSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-962-6348
Mailing Address - Street 1:107 E MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-5312
Mailing Address - Country:US
Mailing Address - Phone:509-962-6348
Mailing Address - Fax:509-962-2003
Practice Address - Street 1:107 E MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-5312
Practice Address - Country:US
Practice Address - Phone:509-962-6348
Practice Address - Fax:509-962-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4582OtherGROUP HEALTH
WA33120OtherLABOR & INDUSTRIES
WA7047830Medicaid