NPIMap

Garfield County Memorial Hospital District

Organization Active NPI Rural Health Clinic/Center · Pomeroy, WA

NPI 1114028693 · NPPES record last updated Oct 25, 2024

Key facts

NPI
1114028693
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
503982 (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
Organization subpart
Yes
Parent organization (as reported)
GARFIELD COUNTY PUBLIC HOSPITAL DISTRICT #1

Authorized official

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

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 5

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

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

Facilities with the same owner 1

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

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WA

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
Government · Non-profit
Incorporated
Feb 1, 1948 in WA
Enrollment address
446 Pataha St
Pomeroy, WA 99347-8634
Related CCNs
501301

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 Director
Board of Commisioners		 Dec 6, 2021 20%
Mat Slaybaugh
Individual 		Corporate Officer
Ceo		 Jan 1, 2025
Allie Hyer
Individual 		Corporate Director
Board 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 Director
Board Member		 Jan 1, 2018 20%
Stephanie Miller
Individual 		Corporate Officer Jan 1, 2025
W-2 Managing Employee
Cfo		 Jan 1, 2025
Hollie Winslow
Individual 		W-2 Managing Employee
Business Office Manager		 Jan 1, 2025
Sherry Ledgerwood
Individual 		Corporate Director
Board of Commisioners		 Dec 6, 2021 20%

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Garfield County Memorial (6 organizations share this tax ID)
Part of
Garfield County Memorial

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
7023161MedicaidWA
7105463OtherWAMEDICA RURAL HEALTH ENCO

Other names

  • Pomeroy Medical Clinic Other name

Other providers in Pomeroy, WA

All providers in Pomeroy, WA · Rural Health Clinic/Center in Washington

Sources for this page

Verify at the official NPI Registry.