Provider Demographics
NPI:1134831415
Name:PEND OREILLE COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity type:Organization
Organization Name:PEND OREILLE COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-447-9310
Mailing Address - Street 1:714 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-9046
Mailing Address - Country:US
Mailing Address - Phone:509-447-9363
Mailing Address - Fax:509-447-2485
Practice Address - Street 1:336 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9671
Practice Address - Country:US
Practice Address - Phone:509-447-2484
Practice Address - Fax:509-447-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy