Provider Demographics
NPI:1134169493
Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Entity type:Organization
Organization Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVARY
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:509-786-2222
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:723 MEMORIAL ST
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1524
Practice Address - Country:US
Practice Address - Phone:509-786-2222
Practice Address - Fax:509-786-6612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA046314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4204608Medicaid
WA116423OtherLABOR AND INDUSTRIES #
WA116423OtherLABOR AND INDUSTRIES #