Provider Demographics
NPI:1871627281
Name:COUNTY OF WALLA WALLA
Entity type:Organization
Organization Name:COUNTY OF WALLA WALLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:DVM, MS, DACVPM
Authorized Official - Phone:509-524-2655
Mailing Address - Street 1:314 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2821
Mailing Address - Country:US
Mailing Address - Phone:509-524-2650
Mailing Address - Fax:509-524-2678
Practice Address - Street 1:314 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2821
Practice Address - Country:US
Practice Address - Phone:509-524-2650
Practice Address - Fax:509-524-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7010705Medicaid
WA7402068Medicaid
WA8025744Medicaid
WA8275653Medicaid
WA7010705Medicaid
WAG001300267Medicare ID - Type UnspecifiedMEDICARE PART B