1265791065 NPI number — PUBLIC HOSPITAL DIST NO 1 SKAGIT

Table of content: (NPI 1265791065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265791065 NPI number — PUBLIC HOSPITAL DIST NO 1 SKAGIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HOSPITAL DIST NO 1 SKAGIT
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:
CASCADE VALLEY HOSPITAL PHYSICIANS
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:
1265791065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E KINCAID ST
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98274-4127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-428-2500
Provider Business Mailing Address Fax Number:
360-428-6485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 S STILLAGUAMISH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-435-2133
Provider Business Practice Location Address Fax Number:
360-435-0513
Provider Enumeration Date:
05/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ISHIZUKA
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
360-814-5838

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  00000106 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: 00000106 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 00000106 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: HAC.FS.00000106 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 000000106 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 355079 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2061042 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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