NPIMap

Organization Active NPI

Tri-State Memorial Hospital

  • Community Based Hospice Care Agency
  • Clarkston, WA
National Provider Identifier
1831100254
Registry record updated May 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
IS457 Issued in WA
Legal business name
TRI-STATE MEMORIAL HOSPITAL
Practice address
1100 Highland Avenue
Clarkston, WA 99403
Phone
(509) 758-2568
Fax
(509) 758-3413
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2013

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

Authorized official

Name
Alex C Town
Title
Cfo
Phone
(509) 758-4667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X IS457 WA Primary

Addresses

Primary practice location

1100 Highland Avenue
Clarkston, WA 99403

Mailing address

PO Box 189
Clarkston, WA 99403-0189
Phone (509) 758-5511

Other identifiers 1

IdentifierTypeStateIssuer
3990470MedicaidWA

National Provider Directory

National Provider Directory

Locations

2841 Juniper Dr
#2
Lewiston, ID 83501
Phone (208) 848-9001

1119 Highland Ave
Ste 8
Clarkston, WA 99403
Phone (509) 751-0223

Practitioners & affiliated clinicians

Practitioners 149

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

View all 149

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1831100254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994030189",
            "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": "1100 HIGHLAND AVENUE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "99403",
            "telephone_number": "509-758-2568",
            "fax_number": "509-758-3413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2013-05-08",
        "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": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WA",
            "license": "IS457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3990470",
            "state": "WA"
        }
    ],
    "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 May 8, 2013; 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.