Healthcare Provider Details

I. General information

NPI: 1356439699
Provider Name (Legal Business Name): PUBLIC HOPSITAL DISTRICT NO 1 OF MASON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 PROFESSIONAL WAY
SHELTON WA
98584-0011
US

IV. Provider business mailing address

PO BOX 1668
SHELTON WA
98584
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-3102
  • Fax: 360-426-9866
Mailing address:
  • Phone: 360-426-3102
  • Fax: 360-426-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC MOLL
Title or Position: CEO
Credential:
Phone: 360-427-9554