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2811 Tieton Dr Yakima WA 98902-3761 | |
| (509) 575-8000 | |
| (509) 574-5800 |
| Full Name | |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 2811 Tieton Dr, Yakima, Washington |
| Authorized Official Name and Position | Kelly Williams (MANAGER, PROVIDER DATA & ENROLLMENT) |
| Authorized Official Contact | 2534598009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2811 Tieton Dr Yakima WA 98902-3761 Ph: (509) 575-8000 | 2811 Tieton Dr Yakima WA 98902-3761 Ph: (509) 575-8000 |
| NPI Number | 1053373480 |
|---|---|
| Provider Enumeration Date | 04/03/2006 |
| Last Update Date | 06/27/2024 |
| Certification Date | 06/27/2024 |
| Medicare PECOS PAC ID | 5698661890 |
|---|---|
| Medicare Enrollment ID | O20080226000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053373480 | NPI | - | NPPES |
| 3307501 | Medicaid | WA | |
| 3500436 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 3500436 (Washington) | Secondary |
| 282N00000X | General Acute Care Hospital | H-058 (Washington) | Primary |
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