Healthcare Provider Details

I. General information

NPI: 1760582522
Provider Name (Legal Business Name): PACIFIC COUNTY HOSPITAL DISTRICT 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 ALDER ST
SOUTH BEND WA
98586-4900
US

IV. Provider business mailing address

PO BOX 269 826 ALDER ST.
SOUTH BEND WA
98586-0269
US

V. Phone/Fax

Practice location:
  • Phone: 360-875-5579
  • Fax: 360-875-5235
Mailing address:
  • Phone: 360-875-5579
  • Fax: 360-875-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY MCALLISTER
Title or Position: CLINIC MANAGER
Credential:
Phone: 360-875-5579