Organization
COLUMBIA BASIN HEALTH ASSOCIATION
Active
Other names
Columbia Basin Health Association
Organization subpart
No
Provider details
NPI number
Authorized official
NIEVES GOMEZ (CEO)
(509) 488-5256
Entity
Organization
Contact information
Practice address
601 GOVERNMENT WAY, MATTAWA, WA 99349
(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
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035900
DLI GROUP#
WA
01
—
50-1877
MEDICARE PTAN#
WA
01
—
7107675
UGS MDC DSHS CROSSOVER
WA
01
—
8908941
DLI CRIME VICTIMS#
WA
01
—
C03323
RAILROAD MEDICARE#
WA
Enumeration date
07/16/2012
Last updated
05/06/2022
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