Healthcare Provider Details

I. General information

NPI: 1255401683
Provider Name (Legal Business Name): GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W SIMPSON AVE
MCCLEARY WA
98557-9657
US

IV. Provider business mailing address

600 E. MAIN STREET
ELMA WA
98541
US

V. Phone/Fax

Practice location:
  • Phone: 360-346-2222
  • Fax:
Mailing address:
  • Phone: 360-346-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberHAC.FS.00000186
License Number StateWA

VIII. Authorized Official

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