Healthcare Provider Details

I. General information

NPI: 1265155568
Provider Name (Legal Business Name): WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77-6349 HALAWAI PL
KAILUA KONA HI
96740-2287
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARTH A MILLER
Title or Position: COO
Credential: MD
Phone: 360-678-7656