Healthcare Provider Details

I. General information

NPI: 1467522896
Provider Name (Legal Business Name): GRAYS HARBOR PUBLIC HOSPITAL DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E. MAIN STREET
ELMA WA
98541
US

IV. Provider business mailing address

322 S BIRCH ST
MCCLEARY WA
98557-9522
US

V. Phone/Fax

Practice location:
  • Phone: 360-495-3500
  • Fax: 360-495-4423
Mailing address:
  • Phone: 360-495-3500
  • Fax: 360-495-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: MS. RENEE K JENSEN
Title or Position: CEO
Credential:
Phone: 360-346-2222