Healthcare Provider Details

I. General information

NPI: 1922196609
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 KATI CT SUITE C
SHELTON WA
98584-1926
US

IV. Provider business mailing address

2300 KATI CT SUITE C
SHELTON WA
98584-1900
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-8717
  • Fax:
Mailing address:
  • Phone: 360-426-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE ROBERT APPEL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 360-427-9556