Healthcare Provider Details

I. General information

NPI: 1578649794
Provider Name (Legal Business Name): OKANOGAN DOUGLAS COUNTY HOSPITAL DIST1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HOSPITAL WAY
BREWSTER WA
98812-0507
US

IV. Provider business mailing address

PO BOX 577
BREWSTER WA
98812-0577
US

V. Phone/Fax

Practice location:
  • Phone: 509-689-2517
  • Fax: 509-689-2086
Mailing address:
  • Phone: 509-689-2517
  • Fax: 509-689-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH23
License Number StateWA

VIII. Authorized Official

Name: JENNIFER MAYE MUNSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 509-689-2517