Tri-State Memorial Hospital
Organization Active NPI Family Medicine Physician · Clarkston, WA
NPI 1932405693 · NPPES record last updated Mar 31, 2011
Key facts
- NPI
- 1932405693
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- 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 28, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- TRI STATE MEMORIAL HOSPITAL
Authorized official
- Name
- Alex Town
- Title
- Cfo
- Phone
- (509) 758-4667
Other NPIs on the same Medicare enrollment 2
Related certifications (CCN) 1
Practitioners 92
-
Bryan James Beardsley, M.D.
-
Dezirae E Berry, NP-C
-
Carol Chandler, NP
-
Elina Chernyak, DO
-
Heather N Davis-Remacle, PA-C
-
Samuel Frankel, MD
-
Harold R Goldberg, MD, FACC
-
Morganne Hamann, PA
-
Andrea N Hedrick, CNM
-
Hannah Bancroft Hug, CRNA, DNP
-
James Lee Hug, DNP, CRNA
-
Karl D Johnson, DPM
-
Nicole Marie Jones, CNM
-
Nancy Koster, M.D.
-
James Onorato, M.D., PH.D.
-
Victoria Ozeran, PA
-
Megan Randall, MSN, FNP-C
-
Daniel Ryan, MD
Affiliated clinicians 191
-
Bryan James Beardsley, M.D.
-
Cory Allen Brown, D.P.M.
-
Justin Carlson, MD
-
Todd M Carpenter, NP
-
Carol Chandler, NP
-
Brian Francis Ciezki, ACNP
-
Natasha Vanessa Demattos, M.D.
-
Marybella Dodson, NURSE PRACTITIONER
-
Mark T Eggleston, MD
-
Samuel Frankel, MD
-
Timothy W Goodrich, D.O.
-
Jacob Gott, PA-C
-
Andrea N Hedrick, CNM
-
Kyle Marlin Hoffmann, PA-C
-
Mark Houghton, ARNP
-
Karl D Johnson, DPM
-
David T Jones, MD
-
Nicole Marie Jones, CNM
-
John Jay Keizur, M.D.
-
Eirene Sarah Kranick, FNP
Medicare Care Compare: Hospital
- Listed as
- Tri-State Memorial Hospital
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Hospital certification: CCN 501332
- Legal name
- TRI-STATE MEMORIAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Aug 1, 2004
- Last certification
- Nov 29, 2012
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 19, 1999 in WA
- Enrollment address
- 1119 Highland Ave
Ste 4
Clarkston, WA 99403-2836
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| John Seeh |
Corporate Director | May 1, 2012 | |
| Eddie Wayne Day |
Corporate Director | Jun 24, 2004 | |
| Kimberly Clift |
W-2 Managing Employee | Apr 1, 2021 | |
| Donald McQuary |
Corporate Director | Jun 24, 2004 | |
| Debra Ausman |
Corporate Director | May 1, 2012 | |
| Dawn Larae Merrill |
Corporate Director | Jun 24, 2004 | |
| Steve Claassen |
Corporate Director | Nov 19, 2007 | |
| Kevin David Hagen |
Corporate Director | Mar 1, 2006 | |
| Sandy K Blume |
W-2 Managing Employee | May 1, 2012 | |
| Richard Flerchinger |
Corporate Director | Jun 24, 2004 | |
| Rhonda Mason |
Corporate Director | Dec 8, 1999 | |
| W-2 Managing Employee | Dec 8, 1999 | ||
| Daniel Klaveano |
Corporate Director | May 1, 2012 | |
| Scott Arnone |
Corporate Director | Jun 24, 2004 | |
| Michael Martin |
Corporate Director | Jun 24, 2004 |
Medicare enrollment records
| 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 This NPI is an additional NPI on the enrollment Practice locations: Clarkston, WA |
| O20061104000320 | WA | Part a Provider - Critical Access Hospital | 4082502422 |
Receives reassigned benefits from 157 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clarkston, WA |
National Provider Directory
- Part of
- Tri-State Hosp Supplier
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Nephrology Physician |
207RN0300X |
Addresses
Primary practice location
1221 Highland Ave
Clarkston, WA 99403-2829
Mailing address
PO Box 189
Clarkston, WA 99403-0189
Phone (509) 758-5511
Other names
- Tri State Medical Clinics
Other providers in Clarkston, WA
- Tri-State Memorial Hospital
- Tri-State Memorial Hospital
- Tri-State Memorial Hospital
- Tri-State Memorial Hospital
- Tri-State Memorial Hospital
- Tri-State S.P.O.R.T. Physical Therapy Clinic
- Twin Cities Pain Management PC
- Twin Cities Radiology, Inc
- Twin River Vision, Inc.
- Twin Rivers Physical Therapy, LLC
All providers in Clarkston, WA · Family Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2011. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.