Healthcare Provider Details

I. General information

NPI: 1649324674
Provider Name (Legal Business Name): LEWIS COUNTY HOSPITAL DIST #1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ADAMS AVENUE
MORTON WA
98356
US

IV. Provider business mailing address

PO BOX 508
MOSSYROCK WA
98564-0508
US

V. Phone/Fax

Practice location:
  • Phone: 360-496-5112
  • Fax:
Mailing address:
  • Phone: 360-496-3702
  • Fax: 360-983-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License NumberH173
License Number StateWA

VIII. Authorized Official

Name: TIM COURNYER
Title or Position: CFO
Credential:
Phone: 360-496-3701