Healthcare Provider Details

I. General information

NPI: 1205882909
Provider Name (Legal Business Name): LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ADAMS AVENUE
MORTON WA
98356
US

IV. Provider business mailing address

PO BOX 1138
MORTON WA
98356-0019
US

V. Phone/Fax

Practice location:
  • Phone: 360-496-5112
  • Fax: 360-496-3511
Mailing address:
  • Phone: 360-496-5112
  • Fax: 360-983-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberH173
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH173
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH173
License Number StateWA

VIII. Authorized Official

Name: RICHARD BOGGESS
Title or Position: CFO
Credential:
Phone: 360-496-3647