NPIMap

Organization Active NPI

Columbia Basin Health Association

  • Pharmacist
  • Othello, WA
National Provider Identifier
1407919186
Registry record updated May 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
CF00003080 Issued in WA
Legal business name
COLUMBIA BASIN HEALTH ASSOCIATION
Doing business as
Columbia Basin Health Association
Practice address
1515 E Columbia St
Othello, WA 99344-1846
Phone
(509) 488-5256
Fax
(509) 488-9939
NPI assigned
Dec 18, 2006
Last updated
May 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2022

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

Authorized official

Name
Nieves Gomez
Title
Ceo
Phone
(509) 488-5256

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X CF00003080 WA
Pharmacist 183500000X CF00003080 WA Primary

Addresses

Primary practice location

1515 E Columbia St
Othello, WA 99344-1846

Mailing address

1515 E Columbia St
Othello, WA 99344-1846
Phone (509) 488-5256

Other identifiers 1

IdentifierTypeStateIssuer
4918314OtherWANABP #

Other names 1

  • Columbia Basin Health Association Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930030134 WA DME Supplier - PharmacyDME Supplier - Physician - Optometrist 4486564309 Practice locations: Othello, WA

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Columbia Basin Health17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Columbia Basin Health AssociationPasco, WA, CCN 501042 Federally qualified health center Operational/Managerial Control (100%) Mar 18, 2018

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1407919186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA BASIN HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-05-04",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "NIEVES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-488-5256"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "CF00003080",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "CF00003080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP #",
            "identifier": "4918314",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Basin Health Association",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbia Basin Health Association",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Othello, WA

Sources for this page

Verify at the official NPI Registry.