Healthcare Provider Details

I. General information

NPI: 1831131135
Provider Name (Legal Business Name): PUBLIC HOSPITAL DIST NO 1 SKAGIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

IV. Provider business mailing address

1410 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-6465
  • Fax: 360-428-6409
Mailing address:
  • Phone: 360-428-6465
  • Fax: 360-428-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60170291
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LITAKER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: BS RPH
Phone: 360-424-2512