Provider Demographics
NPI:1770711764
Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-7424
Mailing Address - Street 1:P.O. BOX 799
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-933-8771
Mailing Address - Fax:509-933-8692
Practice Address - Street 1:100 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3692
Practice Address - Country:US
Practice Address - Phone:509-933-8777
Practice Address - Fax:509-933-8741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-140261QP2300X
WA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0248379OtherL&I
WA7114267Medicaid
WAHAC.FS.00000140OtherWASHINGTON STATE DEPARTMENT OF HEALTH CERTIFICATION NUMBER
WA7114267Medicaid