Healthcare Provider Details

I. General information

NPI: 1508431727
Provider Name (Legal Business Name): WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14014 38TH AVE NE
SEATTLE WA
98125-3802
US

IV. Provider business mailing address

101 N MAIN ST
COUPEVILLE WA
98239-3413
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-5151
  • Fax: 360-678-7676
Mailing address:
  • Phone: 360-678-5151
  • Fax: 866-442-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD TELLES
Title or Position: CEO
Credential:
Phone: 360-678-7656