Organization
TRI-STATE MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. 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
282NC0060X
Critical Access Hospital
Primary
H-108
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002128
REGENCE BLUE SHIELD OF IDAHO
—
05
—
003110900
—
ID
05
—
003308004
—
WA
01
—
00620
BLUE CROSS OF IDAHO
—
Enumeration date
05/27/2005
Last updated
03/24/2011
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