Organization
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Active
Other names
KVH Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TARA J PRECIADO (BILLING SUPERVISOR)
(509) 962-9841
Entity
Organization
Contact information
Practice address
700 E MANITOBA AVE STE 109, ELLENSBURG, WA 98926-3885
(509) 925-8445
(509) 925-8464
Mailing address
P.O. BOX 799, ELLENSBURG, WA 98926
(509) 933-8771
(509) 962-7604
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
H 140
WA
261QR1300X
Rural Health Clinic/Center
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202873
LABOR & INDUST
WA
01
—
152
BLUE CROSS
WA
05
—
7120595
—
WA
Enumeration date
07/31/2006
Last updated
08/03/2021
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