1689604563 NPI number — LEWIS COUNTY HOSPITAL DISTRICT NO. 1

Table of content: (NPI 1689604563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689604563 NPI number — LEWIS COUNTY HOSPITAL DISTRICT NO. 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS COUNTY 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:
ARBOR HEALTH RANDLE 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:
1689604563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1138
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98356-0019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-496-5112
Provider Business Mailing Address Fax Number:
360-496-3504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 KINDLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-497-3333
Provider Business Practice Location Address Fax Number:
360-497-5073
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOGGESS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
360-496-5112

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  H173 , 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: 7111230 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB0062 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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