Organization
COLUMBIA BASIN HEALTH ASSOCIATION
Active
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
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Mailing address
1515 E. COLUMBIA ST., OTHELLO, WA 99344
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
WA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
OD00003794
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035900
DEPT L&I #
WA
05
—
2029130
—
WA
01
—
7107675
UGS MDC DSHS CROSSOVER
WA
01
—
8908941
CRIME VICTIMS #
WA
Enumeration date
04/23/2007
Last updated
05/06/2022
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