Healthcare Provider Details

I. General information

NPI: 1245497577
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT NO 1 OF SNOHOMISH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W STEVENS AVE HWY 2 SKY VALLEY FAMILY MEDICINE
SULTAN WA
98294-9458
US

IV. Provider business mailing address

14701 179TH AVE SE
MONROE WA
98272-1108
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7497
  • Fax:
Mailing address:
  • Phone: 360-794-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberH104
License Number StateWA

VIII. Authorized Official

Name: MR. MARK D JUDY
Title or Position: CEO
Credential:
Phone: 360-794-1447