1740211028 NPI number — GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1

Table of content: (NPI 1740211028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740211028 NPI number — GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAYS HARBOR 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:
1740211028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 E. MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-495-3244
Provider Business Mailing Address Fax Number:
360-495-4274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-495-3244
Provider Business Practice Location Address Fax Number:
360-495-4274
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
360-346-2222

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18090 . This is a "L&I ER DOC NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 18091 . This is a "L&I ER FACILITY NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7257108 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3147709 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8918276 . This is a "CRIME VICTIM PRO FEE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8903273 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 135 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GR6577 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: QMXPR0048030 . This is a "MOLINA H/O" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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