Provider Demographics
NPI:1821394750
Name:WALLA WALLA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WALLA WALLA GENERAL HOSPITAL
Other - Org Name:ADVENTIST HEALTH SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOCKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-527-8000
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0309
Mailing Address - Country:US
Mailing Address - Phone:509-525-4900
Mailing Address - Fax:509-522-3886
Practice Address - Street 1:1017 S 2ND AVE
Practice Address - Street 2:STE 1
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4183
Practice Address - Country:US
Practice Address - Phone:509-525-4900
Practice Address - Fax:509-522-3886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALLA WALLA GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011603Medicaid
WA2011603Medicaid