Provider Demographics
NPI:1609093954
Name:ADMAS COUNTY PULIC HOSPITAL NO. 3
Entity Type:Organization
Organization Name:ADMAS COUNTY PULIC HOSPITAL NO. 3
Other - Org Name:OTHELLO COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:509-488-2636
Mailing Address - Street 1:315 N 14TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1254
Mailing Address - Country:US
Mailing Address - Phone:509-488-2636
Mailing Address - Fax:509-488-3857
Practice Address - Street 1:315 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1254
Practice Address - Country:US
Practice Address - Phone:509-488-2636
Practice Address - Fax:509-488-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH125275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
50Z318Medicare ID - Type Unspecified