1881135499 NPI number — LEWIS COUNTY COMMUNITY HEALTH SERVICES

Table of content: (NPI 1881135499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881135499 NPI number — LEWIS COUNTY COMMUNITY HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS COUNTY COMMUNITY HEALTH SERVICES
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:
VALLEY VIEW HEALTH CENTER - TENINO
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:
1881135499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2690 NE KRESKY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEHALIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98532-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-330-9595
Provider Business Mailing Address Fax Number:
360-330-9560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
273 SUSSEX AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TENINO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98589-9359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-264-5665
Provider Business Practice Location Address Fax Number:
360-264-5666
Provider Enumeration Date:
03/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
360-330-9595

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  602312048 , 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: G8801670 . This is a "MEDICARE PART B" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7126972 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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