Organization
TRI-STATE MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX C TOWN (CFO)
(509) 758-4667
Entity
Organization
Contact information
Practice address
1221 HIGHLAND AVENUE, CLARKSTON, WA 99403
(509) 758-5511
(509) 751-9406
Mailing address
PO BOX 189, CLARKSTON, WA 99403
(509) 758-5511
(509) 751-9406
Taxonomy
Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
Primary
H108
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3308004
—
WA
05
—
806933500
—
ID
Enumeration date
11/20/2006
Last updated
09/21/2012
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