Organization
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
Active
Other names
Mattawa Community Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DANA S FOX CMA (CEO/EXECUTIVE DIRECTOR)
(509) 932-4499
Entity
Organization
Contact information
Practice address
210 GOVERNMENT ROAD, MATTAWA, WA 99349-0960
(509) 932-4499
(509) 932-5363
Mailing address
210 GOVERNMENT RD, MATTAWA, WA 99349-5116
(509) 932-4499
(509) 932-5363
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WA
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
501944
MEDICARE PTAN
WA
01
—
67850
LABOR & INDUSTRIES
WA
01
—
7035611
DSHS FEE FOR SERVICE
WA
05
—
7044167
—
WA
01
—
7406572
DSHS MSS
WA
01
—
7900657
DSHS TAKE CHARGE
WA
Enumeration date
05/24/2006
Last updated
06/04/2025
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