| Columbia Basin Health Association | |
|
475 N 14th Ave Othello WA 99344-1226 | |
| (509) 488-6644 | |
| (509) 488-9939 |
| Full Name | Columbia Basin Health Association |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 475 N 14th Ave, Othello, Washington |
| Authorized Official Name and Position | Nieves Gomez (CEO) |
| Authorized Official Contact | 5094885256 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Basin Health Association 1515 E Columbia St Othello WA 99344-1846 Ph: (509) 488-5256 | Columbia Basin Health Association 475 N 14th Ave Othello WA 99344-1226 Ph: (509) 488-6644 |
| NPI Number | 1972721710 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 05/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972721710 | NPI | - | NPPES |
| 50D0640014 | Other | WA | CLIA # |
| 7121585 | Medicaid | WA | |
| 08908941 | Other | WA | CRIME VICTIMS # |
| 7406119 | Medicaid | WA | |
| 7900624 | Other | WA | TAKE CHARGE # |
| 0035900 | Other | WA | DEPT L&I # |
| 7107675 | Other | WA | UGS MDC DSHS CROSSOVER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (Washington) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Washington) | Primary |
Columbia Basin Health Association Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1515 E Columbia St, Othello, WA 99344 Phone: 509-488-5256 Fax: 509-488-9939 | |
Columbia Basin Health Association Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1515 E Columbia St, Othello, WA 99344 Phone: 509-488-5256 Fax: 509-488-9939 | |
Columbia Basin Health Association Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1515 E Columbia St, Othello, WA 99344 Phone: 509-488-5256 Fax: 509-488-9939 |