Provider Demographics
NPI:1659445468
Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT 2
Entity Type:Organization
Organization Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT 2
Other - Org Name:QUINCY VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-787-5346
Mailing Address - Street 1:908 10TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1376
Mailing Address - Country:US
Mailing Address - Phone:509-787-3531
Mailing Address - Fax:509-787-2016
Practice Address - Street 1:908 10TH AVE SW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1376
Practice Address - Country:US
Practice Address - Phone:509-787-3531
Practice Address - Fax:509-787-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH129207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7033426Medicaid
WA7103930Medicaid
WA7033426Medicaid