NPIMap

Organization Active NPI

Garfield County Memorial Hospital District

  • Rural Health Clinic/Center
  • Pomeroy, WA
National Provider Identifier
1114028693
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
503982 Issued in WA
Legal business name
GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT
Practice address
446 Pataha St
Pomeroy, WA 99347-8634
Phone
(509) 843-1491
Fax
(509) 843-1740
NPI assigned
Sep 26, 2006
Last updated
Oct 25, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GARFIELD COUNTY PUBLIC HOSPITAL DISTRICT #1As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hollie Winslow
Title
Business Office Manager
Phone
(509) 566-4147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 503982 WA Primary

Addresses

Primary practice location

446 Pataha St
Pomeroy, WA 99347-8634

Mailing address

66 N 6TH St
Pomeroy, WA 99347-9705
Phone (509) 843-1491

Other names 1

  • Pomeroy Medical Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309001450 WA Part B Supplier - Clinic/Group Practice 2668360769 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
Practice locations: Pomeroy, WA
O20060505000211 WA Part A Provider - Rural Health Clinic 2668360769 Practice locations: Pomeroy, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114028693. Details of each certification follow.

Rural health clinic certification: CCN 503982

Legal name
GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT
Doing business as
POMEROY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 17, 1993
Last certification
Sep 7, 2022
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Feb 1, 1948 in WA
Enrollment address
446 Pataha St
Pomeroy, WA 99347-8634
Related CCNs
501301

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D1044707Pomeroy Medical Clinic446 Pataha St, Pomeroy, WA 99347Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Garfield County Public Hospital District 16 organizations share this tax ID, including this one
Part of
Garfield County Public Hospital District 1

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Erica Stallcop Individual Corporate DirectorBoard of Commisioners Dec 6, 2021 20%
Mat Slaybaugh Individual Corporate OfficerCeo Jan 1, 2025
Allie Hyer Individual Corporate DirectorBoard Member Jan 1, 2026 20%
Jennifer Dixon Individual Corporate Director Nov 1, 2017 20%
Garfield County Memorial Hospital District Organization, Pomeroy, WA Operational/Managerial Control Jan 1, 1966 100%
Steven Cannon Individual Corporate DirectorBoard Member Jan 1, 2018 20%
Stephanie Miller Individual Corporate Officer Jan 1, 2025
W-2 Managing EmployeeCfo Jan 1, 2025
Hollie Winslow Individual W-2 Managing EmployeeBusiness Office Manager Jan 1, 2025
Sherry Ledgerwood Individual Corporate DirectorBoard of Commisioners Dec 6, 2021 20%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Garfield County Public Hospital District #1Pomeroy, WA, CCN 501301 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1966
Garfield County Memorial Hospital and LTCPomeroy, WA, CCN 50Z301 Hospital Other Jan 1, 1966

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1114028693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 N 6TH ST",
            "city": "POMEROY",
            "state": "WA",
            "postal_code": "993479705",
            "telephone_number": "509-843-1491",
            "fax_number": "509-843-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 PATAHA ST",
            "city": "POMEROY",
            "state": "WA",
            "postal_code": "993478634",
            "telephone_number": "509-843-1491",
            "fax_number": "509-843-1740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GARFIELD COUNTY PUBLIC HOSPITAL DISTRICT #1",
        "enumeration_date": "2006-09-26",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "WINSLOW",
        "authorized_official_first_name": "HOLLIE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "509-566-4147"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "503982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pomeroy Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pomeroy, WA

Sources for this page

Verify at the official NPI Registry.