Provider Demographics
NPI:1689779324
Name:PUBLIC HOSPITAL DISTRICT NO 2, KLICKITAT COUNTY, WASHINGTON
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT NO 2, KLICKITAT COUNTY, WASHINGTON
Other - Org Name:SKYLINE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-493-1101
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672
Mailing Address - Country:US
Mailing Address - Phone:509-493-1101
Mailing Address - Fax:509-493-4607
Practice Address - Street 1:211 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672
Practice Address - Country:US
Practice Address - Phone:509-493-1101
Practice Address - Fax:509-493-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-096282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4209607Medicaid
WA4209607Medicaid