NPIMap

Organization Active NPI

Grant County Public Hospital District No 5

Doing business as Mattawa Community Medical Clinic

  • Community/Retail Pharmacy
  • Mattawa, WA
National Provider Identifier
1396384871
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
Doing business as
Mattawa Community Medical Clinic
Practice address
210 Government Road
Mattawa, WA 99349
Phone
(509) 932-4119
Fax
(509) 932-4086
NPI assigned
Dec 31, 2019
Last updated
Dec 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
1699720797As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Authorized official

Name
Dana S Fox
Title
Ceo
Phone
(509) 932-4499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

210 Government Road
Mattawa, WA 99349

Mailing address

210 Government Rd
Mattawa, WA 99349-5116
Phone (509) 932-4119

Other names 1

  • Mattawa Community Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grant County Public Hospital District No 54 organizations share this tax ID, including this one
Part of
Grant County Public Hospital District No 5

Other organizations with this tax ID 3

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

Locations

210 Government Rd
Mattawa, WA 99349
Phone (509) 932-4499

NPI Registry JSON

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

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1396384871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 GOVERNMENT RD",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "993495116",
            "telephone_number": "509-932-4119",
            "fax_number": "509-932-4086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 GOVERNMENT ROAD",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "99349",
            "telephone_number": "509-932-4119",
            "fax_number": "509-932-4086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1699720797",
        "enumeration_date": "2019-12-31",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-932-4499"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mattawa Community Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mattawa Community Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mattawa, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.