Organization
COLUMBIA BASIN HEALTH ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIEVES GOMEZ (CEO)
(509) 488-5256
Entity
Organization
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344
(509) 488-5256
(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
261QC1500X
Community Health Clinic/Center
—
WA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WA
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2029130
—
WA
05
—
5019765
—
WA
05
—
5031778
—
WA
05
—
6022537
—
WA
05
—
6023337
—
WA
05
—
7062425
—
WA
05
—
7096555
—
WA
05
—
7107675
—
WA
05
—
7121585
—
WA
05
—
7406119
—
WA
05
—
7406127
—
WA
05
—
7407828
—
WA
05
—
7407927
—
WA
05
—
7590177
—
WA
05
—
7900624
—
WA
Enumeration date
06/04/2006
Last updated
05/06/2022
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