Organization
TRI-STATE MEMORIAL HOSPITAL
Active
Parent organization
TRI-STATE MEMORIAL HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRI-STATE MEMORIAL HOSPITAL
Authorized official
ALEX C TOWN (CFO)
(509) 758-4667
Entity
Organization
Contact information
Practice address
1221 HIGHLAND AVE, CLARKSTON, WA 99403-2829
(509) 758-5511
(509) 751-9406
Mailing address
1221 HIGHLAND AVE, CLARKSTON, WA 99403-2829
(509) 758-5511
(509) 751-9406
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RN0300X
Nephrology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
282NC0060X
Critical Access Hospital
Primary
H-108
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142729
REGENCE BLUE SHEILD
ID
05
—
003111000
—
ID
05
—
007032733
—
WA
01
—
0082114
LABOR AND INDUSTRIES
WA
01
—
8K289
BLUE CROSS OF IDAHO
ID
Enumeration date
01/10/2007
Last updated
07/05/2013
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