Active NPI
Tri-State Memorial Hospital
- Critical Access Hospital
- Clarkston, WA
National Provider Identifier
1598814352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Access Hospital
- License
- H-108
- Legal business name
- TRI-STATE MEMORIAL HOSPITAL
- Practice address
- 1221 Highland Ave
Clarkston, WA 99403-2829 - Phone
- (509) 758-5511
- Fax
- (509) 751-9406
- NPI assigned
- Jan 10, 2007
- Organization subpart
- Yes
- Parent organization
- TRI-STATE MEMORIAL HOSPITAL
Authorized official
NPPES NPI Registry- Name
- Alex C Town
- Title
- Cfo
- Phone
- (509) 758-4667
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Lewiston, ID
- NPI 1386690907
O20040911000031
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Medicare Defined Swing Bed Hospital Unit
- Clarkston, WA
- NPI 1174697353
4082502422
Practitioners 190
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Clarkston, WA
- NPI 1679504559
ID, Internal Medicine, WA
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA, ID
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040308001123 | WA | Part B Supplier - Clinic/Group Practice | 4082502422 |
Receives reassigned benefits from 159 practitioners 1 other NPI on this enrollment Practice locations: Clarkston, WA |
| O20040911000031 | ID | Part B Supplier - Clinic/Group Practice | 4082502422 |
Receives reassigned benefits from 28 practitioners 1 other NPI on this enrollment Practice locations: Lewiston, ID |
National Provider Directory
National Provider Directory- Part of
- Tri-State Hosp Supplier
Locations
1207 Evergreen Ct
Clarkston, WA 99403
Phone (509) 751-0600
1119 Highland Ave
Ste 7
Clarkston, WA 99403
Phone (509) 758-1119
1271 Highland Ave
Clarkston, WA 99403
Phone (509) 751-1500
1119 Highland Ave
Ste 11
Clarkston, WA 99403
Phone (509) 758-4450
Specialties & licenses 6
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Internal Medicine Physician | 207R00000X | |||
| Nephrology Physician | 207RN0300X | |||
| Surgery Physician | 208600000X | |||
| Urology Physician | 208800000X | |||
| Critical Access Hospital | 282NC0060X | H-108 | WA | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
1221 Highland Ave
Clarkston, WA 99403-2829
Mailing address
1221 Highland Ave
Clarkston, WA 99403-2829
Phone (509) 758-5511
Other identifiers 5
NPPES NPI Registry| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8K289 | Other | ID | BLUE CROSS OF IDAHO |
| 007032733 | Medicaid | WA | |
| 003111000 | Medicaid | ID | |
| 0082114 | Other | WA | LABOR AND INDUSTRIES |
| 000010142729 | Other | ID | REGENCE BLUE SHEILD |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 5, 2013.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1372982400000",
"number": "1598814352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 HIGHLAND AVE",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032829",
"telephone_number": "509-758-5511",
"fax_number": "509-751-9406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 HIGHLAND AVE",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032829",
"telephone_number": "509-758-5511",
"fax_number": "509-751-9406"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRI-STATE MEMORIAL HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TRI-STATE MEMORIAL HOSPITAL",
"enumeration_date": "2007-01-10",
"last_updated": "2013-07-05",
"status": "A",
"authorized_official_last_name": "TOWN",
"authorized_official_first_name": "ALEX",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "509-758-4667"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": false
},
{
"code": "282NC0060X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital, Critical Access",
"state": "WA",
"license": "H-108",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "8K289",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007032733",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003111000",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRIES",
"identifier": "0082114",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHEILD",
"identifier": "000010142729",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.