1235213034 NPI number — CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1

Table of content: (NPI 1235213034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235213034 NPI number — CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLALLAM BAY MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235213034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLALLAM BAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-374-6271
Provider Business Mailing Address Fax Number:
360-374-9781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 BOGACHIEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLALLAM BAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-963-2202
Provider Business Practice Location Address Fax Number:
360-374-9781
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAMAN
Authorized Official First Name:
STARLA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
360-374-6271

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  H-054 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7102122 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7105315 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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