Healthcare Provider Details

I. General information

NPI: 1518337104
Provider Name (Legal Business Name): GRAYS HARBOR COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 N H ST
ABERDEEN WA
98520-2521
US

IV. Provider business mailing address

915 ANDERSON DR
ABERDEEN WA
98520-1006
US

V. Phone/Fax

Practice location:
  • Phone: 360-537-6496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTONE J EEK
Title or Position: EXECUTIVE DIRECTOR REVENUE CYCLE
Credential:
Phone: 360-581-5495