COLUMBIA BASIN HEALTH ASSOCIATION

Provider Demographics

• NPI: 1619915006
• Name: COLUMBIA BASIN HEALTH ASSOCIATION
• Entity Type: Organization
• Organization Name: COLUMBIA BASIN HEALTH ASSOCIATION
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: NIEVES
• Authorized Official - Last Name: GOMEZ
• Authorized Official - Phone: 509-488-5256
• Mailing Address - Street 1: 1515 E COLUMBIA ST
• Mailing Address - City: OTHELLO
• Mailing Address - State: WA
• Mailing Address - Zip Code: 99344-1846
• Mailing Address - Country: US
• Mailing Address - Phone: 509-488-5256
• Mailing Address - Fax: 509-488-9939
• Practice Address - Street 1: 1515 E COLUMBIA ST
• Practice Address - City: OTHELLO
• Practice Address - State: WA
• Practice Address - Zip Code: 99344
• Practice Address - Country: US
• Practice Address - Phone: 509-488-5256
• Practice Address - Fax: 509-488-9939
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-04
• Last Update Date: 2022-05-06

Provider Licenses

State	License ID	Taxonomies
WA		261QC1500X, 261QF0400X
		261QF0400X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QF0400X	Ambulatory Health Care Facilities	Clinic/Center	Federally Qualified Health Center (FQHC)
No	261QC1500X	Ambulatory Health Care Facilities	Clinic/Center	Community Health

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	7406119	Medicaid
WA	6023337	Medicaid
WA	7062425	Medicaid
WA	7096555	Medicaid
WA	7900624	Medicaid
WA	7107675	Medicaid
WA	7121585	Medicaid
WA	7407828	Medicaid
WA	5031778	Medicaid
WA	6022537	Medicaid
WA	7407927	Medicaid
WA	7590177	Medicaid
WA	2029130	Medicaid
WA	5019765	Medicaid
WA	7406127	Medicaid
WA	7900624	Medicaid
WA	4786550001	Medicare NSC
WA	000346600	Medicare ID - Type Unspecified	GROUP MEDICARE/PART B
WA	501815	Medicare ID - Type Unspecified	MAIN/OTHELLO MEDICARE NBR
WA	6022537	Medicaid
WA	7107675	Medicaid