1285290338 NPI number — CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1

Table of content: PRESTON GARRETT HINES DMD (NPI 1336868405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285290338 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:
Provider Other Organization Name Type Code:
6
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:
1285290338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 BOGACHIEL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORKS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98331-9120
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:
461 G ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORKS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98331-9025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-374-6271
Provider Business Practice Location Address Fax Number:
360-374-9781
Provider Enumeration Date:
05/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MICHEAU
Authorized Official First Name:
CARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE OFFICER
Authorized Official Telephone Number:
360-374-6271

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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