Healthcare Provider Details

I. General information

NPI: 1205375458
Provider Name (Legal Business Name): WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 10/29/2022
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12816 BRIARCREST PL
SAN DIEGO CA
92130-5749
US

IV. Provider business mailing address

101 N MAIN ST
COUPEVILLE WA
98239-3413
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-5151
  • Fax: 360-678-7676
Mailing address:
  • Phone: 360-678-5151
  • Fax: 360-678-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARTH MILLER
Title or Position: CHIEF OPERATING OFFICER
Credential: MD
Phone: 360-678-7676