Grant County Hospital District No. 2
Organization Active NPI Rural Health Clinic/Center · Quincy, WA
NPI 1407920218 · NPPES record last updated Apr 20, 2022
Key facts
- NPI
- 1407920218
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- GRANT COUNTY HOSPITAL DISTRICT NO. 2
- Practice address
- 908 10TH Ave SW
Quincy, WA 98848-1376 - Phone
- (509) 787-3531
- Fax
- (509) 787-2016
- NPI assigned
- Nov 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Glenda L Bishop
- Title
- Ceo
- Phone
- (509) 787-5368
Owners & managing parties with NPI records 3
-
Randy R Zolman, D.C.
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 5
Practitioners 10
-
Amber D Dacy, ARNP
-
Rebekah Marie Garfield, ARNP
-
Julie Ann Thomas, APRN
-
James Buratto, M.D.
-
Fernando Dietsch Jr., M.D.
-
Michael Ian Posch, M.D.
-
Douglas R Diaz, P.T.
-
Alexander Edward Robinson, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Rural health clinic certification: CCN 503976
- Legal name
- GRANT COUNTY HOSPITAL DISTRICT NO. 2
- Doing business as
- QUINCY VALLEY MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 4, 1991
- Last certification
- Sep 10, 2013
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 908 10TH Ave SW
Quincy, WA 98848-1376
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Michele Talley |
Corporate Director | Jan 25, 2016 | |
| Randy R Zolman |
Corporate Director | Jan 1, 2010 | |
| Anthony Gonzalez |
Corporate Director | Jan 1, 2010 | |
| Glenda L Bishop |
Contracted Managing Employee |
Jul 1, 2017 | 100% |
| Corporate Officer |
Jul 1, 2017 | 100% | |
| Corporate Director |
Jul 1, 2017 | 100% | |
| Sherri Kooy |
Corporate Director | Oct 26, 2020 | |
| Grant County Hospital District No. 2 |
Other | Jan 1, 1994 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110513000133 | WA | Part a Provider - Rural Health Clinic | 8921919077 | Practice locations: Quincy, WA |
National Provider Directory
- Tax ID family
- Quincy Valley Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
908 10TH Ave SW
Quincy, WA 98848-1376
Mailing address
908 10TH Ave SW
Quincy, WA 98848-1376
Phone (509) 787-3531
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7105471 | Medicaid | WA | |
| 7590367 | Medicaid | WA | |
| 7600141 | Medicaid | WA | |
| 7033426 | Medicaid | WA |
Other names
- Quincy Valley Medical Center
Other providers in Quincy, WA
- Irene Garza
- Rachel Erin Gaspard
- Kyle Morgan Gillespie
- Hannah Marie Gonzalez
- Beryl M Goto
- Grant County Public Hospital District #2
- Grant County Public Hospital District #2
- Grant County Public Hospital District 2
- Grant County Public Hospital District 2
- Grant County Public Hospital District 2
All providers in Quincy, WA · Rural Health Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.