Healthcare Provider Details

I. General information

NPI: 1154361590
Provider Name (Legal Business Name): WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 SR 525
CLINTON WA
98236
US

IV. Provider business mailing address

PO BOX 24789
SEATTLE WA
98124-0789
US

V. Phone/Fax

Practice location:
  • Phone: 360-341-5252
  • Fax: 360-341-8727
Mailing address:
  • Phone: 360-678-7656
  • Fax: 360-678-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number000092
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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