Organization
TRI-STATE MEMORIAL HOSPITAL
Active
Other names
Tri State Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEX C. TOWN (CFO)
(509) 758-4667
Entity
Organization
Contact information
Practice address
730 21ST ST, LEWISTON, ID 83501-3323
(208) 746-8280
(208) 746-8285
Mailing address
1221 HIGHLAND AVE., PO BOX 189, CLARKSTON, WA 98940
(509) 758-5511
(509) 751-9406
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
H-108
WA
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003110900
—
ID
05
—
3308004
—
WA
Enumeration date
05/25/2006
Last updated
08/04/2009
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