Healthcare Provider Details

I. General information

NPI: 1639165905
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 1ST AVENUE NORTH
IIWACO WA
98624-0319
US

IV. Provider business mailing address

PO BOX N
IIWACO WA
98624-0319
US

V. Phone/Fax

Practice location:
  • Phone: 360-642-3747
  • Fax: 360-642-3361
Mailing address:
  • Phone: 360-642-3747
  • Fax: 360-642-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY COHEN
Title or Position: CEO
Credential:
Phone: 360-642-6300