Provider Demographics
NPI:1932115391
Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity Type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Other - Org Name:KVH INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRECIADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-9841
Mailing Address - Street 1:P.O. BOX 799
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-933-8771
Mailing Address - Fax:509-962-7604
Practice Address - Street 1:700 E MANITOBA AVE STE 109
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3885
Practice Address - Country:US
Practice Address - Phone:509-925-8445
Practice Address - Fax:509-925-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH 140174400000X
WA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7120595Medicaid
WA152OtherBLUE CROSS
WA0202873OtherLABOR & INDUST
WA=========OtherUNIFORM MEDICAL PLAN
WA=========OtherUNIFORM MEDICAL PLAN
WA=========OtherUNIFORM MEDICAL PLAN