WASHINGTON STATE PENITENTIARY (NPI# 1164713558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164713558 |
| Entity Type | Organization |
| Organization Name | WASHINGTON STATE PENITENTIARY |
| Practice Address |
1313 N 13th Ave Walla Walla WA 99362-8817 |
| Mailing Address |
Po Box 41107 Olympia WA 98504-1107 |
| Practice Telephone | 5095253610 |
| Practice Fax Number | 5095266406 |
| Mailing Telephone | 3607258298 |
| Mailing Fax Number | 3605861320 |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |
| Authorized Official Name | LOUIS MCDERMOTT (HEALTHCARE FINANCE MANAGER) |
| Authorized Official Telephone | 3607258301 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEPARTMENT OF CORRECTIONS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2400X |
Clinic/Center Specialization: Prison Health |
Ambulatory Health Care Facilities |
| Street Address |
1313 N 13TH AVE |
| City | WALLA WALLA |
| State | WA |
| Zip Code | 99362-8817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427006246 | Brian Walker | Psychiatry & Neurology | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2006-05-04 |
| 1003449695 | Liam C Wall | Counselor | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2020-02-21 |
| 1811463623 | Cheryl Ann Campbell | Counselor | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2018-10-18 |
| 1235644634 | Thompson & Thompson Physical Therapy, Ps | Clinic/Center | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2017-12-07 |
| 1891200291 | William Lloyd Thompson | Physical Therapist | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2017-12-06 |
| 1598282634 | Teddi Rose Armstrong | Nurse Practitioner | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2017-08-29 |
| 1639542020 | Maxim Healthcare Services, Inc. | Dentist | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2015-11-05 |
| 1588093280 | Jennifer Lauren Meyers | Physician Assistant | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2013-11-04 |
| 1942545710 | Jo Ella Lee Phillips | Physician Assistant | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2012-12-06 |
| 1811206717 | Hugo Jonathan Reyes | Physician Assistant | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2010-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164065959 | Kevin Gia-minh Phan | Optometrist | Walla Walla Vamc Bldg 86, Walla Walla, WA 99362 | 2019-10-24 |
| 1659836401 | Arlene Lavonne Whitney | Social Worker | 1361 Dalles Military Road, Walla Walla, WA 99362 | 2019-02-06 |
| 1053880674 | Julie Ann Cooke | Speech-Language Pathologist | Providence St. Mary Medical Center, 401 W. Poplar St., Walla Walla, WA 99362 | 2018-11-14 |
| 1558887133 | Chantey Walker | Massage Therapist | 1840 Pleasant St, Walla Walla, WA 99362 | 2017-08-16 |
| 1447798723 | Carrie S Diede | Speech-Language Pathologist | 410 West Poplar Street, Rehabilitation Services, Walla Walla, WA 99362 | 2017-02-07 |
| 1235584103 | Anchor Point Counseling Pllc | Clinic/Center | 2330 Eastgate St. Ste. 140, Walla Walla, WA 99362 | 2016-04-28 |
| 1548627011 | Washington State Walla Walla Veterans Home | Skilled Nursing Facility | 92 Wainwright Drive, Walla Walla, WA 99362 | 2016-01-28 |
| 1073926200 | Sherry Goff | Registered Nurse | 11120 W Rose St, Family Medical Center, Walla Walla, WA 99362 | 2014-06-05 |
| 1538597935 | Michael Wade Gillespie | Orthopaedic Surgery | 101 Brookside Drive, Walla Walla, WA 99362 | 2013-10-22 |
| 1023357985 | Sandra Kay Bushnell | Speech-Language Pathologist | 1105 Isaacs Ave, Walla Walla, WA 99362 | 2013-02-12 |
| Find all providers in zip 99362 | ||||
| Taxonomy Code | 261QP2400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Prison Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902197882 | Airway Heights Correction Center | Clinic/Center | 11919 W. Sprague Avenue, Airway Heights, WA 99001-1899 | 2011-04-26 |
| 1194016576 | Olympic Correction Center | Clinic/Center | 11235 Hoh Mainline Rd, Forks, WA 98331-9492 | 2011-04-20 |
| 1538450911 | Larch Corrections Center | Clinic/Center | 15314 Ne Dole Valley Rd, Yacolt, WA 98675-9521 | 2011-04-20 |
| 1861813834 | Wa State Department of Corrections Headquarters | Clinic/Center | 7345 Linderson Way Sw, Tumwater, WA 98501-6504 | 2013-12-18 |
| 1588955306 | Monroe Correctional Complex | Clinic/Center | 16550 177th Ave Se, Monroe, WA 98272 | 2011-04-27 |
| 1750672572 | Cedar Creek Corrections Center | Clinic/Center | 12200 Bordeaux Road, Littlerock, WA 98556-0037 | 2011-04-27 |
| 1114218591 | Washington Corrections Center for Women | Clinic/Center | 9601 Bujacich Rd Nw, Gig Harbor, WA 98332-8300 | 2011-04-20 |
| 1902197387 | Clallam Bay Corrections Center | Clinic/Center | 1830 Eagle Crest Way, Clallam Bay, WA 98326-9724 | 2011-04-20 |
| 1629369095 | Coyote Ridge Corrections Center | Clinic/Center | 1301 N Ephrata Ave, Connell, WA 99326-9601 | 2011-04-20 |
| 1427349802 | Stafford Creek Corrections Center | Clinic/Center | 191 Constantine Way, Aberdeen, WA 98520-9504 | 2011-04-20 |
| Find all providers with the same taxonomy | ||||
| City | WALLA WALLA |
| Zip Code | 99362 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.