Healthcare Provider Details

I. General information

NPI: 1982436788
Provider Name (Legal Business Name): WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 COUNTRY CLUB DR
LEWISTON ID
83501-9603
US

IV. Provider business mailing address

PO BOX 3603
SEATTLE WA
98124-3603
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-5151
  • Fax:
Mailing address:
  • Phone: 360-678-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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