1649324674 NPI number — LEWIS COUNTY HOSPITAL DIST #1

Table of content: (NPI 1649324674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649324674 NPI number — LEWIS COUNTY HOSPITAL DIST #1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS COUNTY HOSPITAL DIST #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:
PHYSICAL THERAPY GROUP
Provider Other Organization Name Type Code:
5
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:
1649324674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSSYROCK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98564-0508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-496-3702
Provider Business Mailing Address Fax Number:
360-983-3098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 ADAMS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-496-5112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COURNYER
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
360-496-3701

Provider Taxonomy Codes

  • Taxonomy code: 261QC0050X , 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: 7135205 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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