Healthcare Provider Details

I. General information

NPI: 1841234598
Provider Name (Legal Business Name): LINCOLN COUNTY HOSPITAL DISTRICT 3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NICHOLLS ST
DAVENPORT WA
99122-9729
US

IV. Provider business mailing address

10 NICHOLLS ST
DAVENPORT WA
99122-9729
US

V. Phone/Fax

Practice location:
  • Phone: 509-725-7101
  • Fax: 509-725-2112
Mailing address:
  • Phone: 509-725-7101
  • Fax: 509-725-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-137
License Number StateWA

VIII. Authorized Official

Name: TYSON E LACY
Title or Position: CEO
Credential:
Phone: 509-725-2979