Organization
COLUMBIA BASIN HEALTH ASSOCIATION
Active
Other names
Wahluke Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA BUNCH (CFO)
(509) 488-5250
Entity
Organization
Contact information
Practice address
601 GOVERNMENT WAY, MATTAWA, WA 99349
(509) 932-3535
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0135012
DEPT OF L&I
WA
01
—
50D9963406
CLIA #
WA
05
—
7096555
—
WA
01
—
7107675
UGS MDC DSHS CROSSOVER
WA
05
—
7407927
—
WA
01
—
7900624
TAKE CHARGE #
WA
01
—
8908941
CRIME VICTIMS #
WA
Enumeration date
04/24/2007
Last updated
07/11/2023
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