Healthcare Provider Details

I. General information

NPI: 1427092162
Provider Name (Legal Business Name): LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/11/2019
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 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: 360-496-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH173
License Number StateWA

VIII. Authorized Official

Name: RICHARD BOGGESS
Title or Position: CFO
Credential:
Phone: 360-496-3525