Provider Demographics
NPI:1780972562
Name:WALLA WALLA GENERAL HOSPITAL
Entity type:Organization
Organization Name:WALLA WALLA GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-0480
Mailing Address - Street 1:1111 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4118
Mailing Address - Country:US
Mailing Address - Phone:509-522-0100
Mailing Address - Fax:509-527-8010
Practice Address - Street 1:1111 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4118
Practice Address - Country:US
Practice Address - Phone:509-522-0100
Practice Address - Fax:509-527-8010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:36300628
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093362Medicaid
WA1093362Medicaid