Healthcare Provider Details

I. General information

NPI: 1093729329
Provider Name (Legal Business Name): WASHINGTON PARK MEDICAL CENTER, INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CENTRALIA COLLEGE BLVD
CENTRALIA WA
98531-4007
US

IV. Provider business mailing address

PO BOX 239
CENTRALIA WA
98531-0239
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-0771
  • Fax: 360-736-4867
Mailing address:
  • Phone: 360-736-0771
  • Fax: 360-736-4867

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: PAUL D WILLIAMS
Title or Position: PHYSICIAN
Credential: MD
Phone: 360-736-0771