Healthcare Provider Details

I. General information

NPI: 1235213034
Provider Name (Legal Business Name): CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BOGACHIEL ST
CLALLAM BAY WA
98326
US

IV. Provider business mailing address

PO BOX 296
CLALLAM BAY WA
98326
US

V. Phone/Fax

Practice location:
  • Phone: 360-963-2202
  • Fax: 360-374-9781
Mailing address:
  • Phone: 360-374-6271
  • Fax: 360-374-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH-054
License Number StateWA

VIII. Authorized Official

Name: STARLA D DAMAN
Title or Position: BILLING MANAGER
Credential:
Phone: 360-374-6271