Healthcare Provider Details

I. General information

NPI: 1396912754
Provider Name (Legal Business Name): OKANOGAN DOUGLAS COUNTY HOSPITAL DISTRICT 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 NORTH MAIN
MANSFIELD WA
98830-0158
US

IV. Provider business mailing address

PO BOX 158 35 NORTH MAIN
MANSFIELD WA
98830-0158
US

V. Phone/Fax

Practice location:
  • Phone: 509-683-1300
  • Fax: 509-683-1313
Mailing address:
  • Phone: 509-683-1300
  • Fax: 509-683-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberH-023
License Number StateWA

VIII. Authorized Official

Name: MS. SANDY WALTER
Title or Position: COO
Credential:
Phone: 509-689-2517