Healthcare Provider Details

I. General information

NPI: 1205110830
Provider Name (Legal Business Name): LEWIS COUNTY HOSPITAL DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 WILLIAMS STREET
MOSSYROCK WA
98564
US

IV. Provider business mailing address

PO BOX 1138
MORTON WA
98356-0019
US

V. Phone/Fax

Practice location:
  • Phone: 360-983-8990
  • Fax: 360-983-8995
Mailing address:
  • Phone: 360-496-3702
  • Fax: 360-983-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH173
License Number StateWA

VIII. Authorized Official

Name: JANICE CRAMER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 360-496-5112