Provider Demographics
NPI:1821556408
Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Entity Type:Organization
Organization Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Other - Org Name:PROSSER WOMEN'S HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-786-2222
Mailing Address - Street 1:723 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1524
Mailing Address - Country:US
Mailing Address - Phone:509-786-6681
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:336 CHARDONNAY AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-9515
Practice Address - Country:US
Practice Address - Phone:509-786-0031
Practice Address - Fax:509-786-0047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-04
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care