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General NPI Number Information
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NPI Number | 1053527853
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Entity Type | Organization
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Legal Business Name | LINCOLN COUNTY HOSPITAL DISTRICT 3
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 10 NICHOLLS ST
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City | DAVENPORT
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State | WA
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Zip | 99122-9729
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Country | US
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Telephone | 509-725-7501
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Fax | 509-725-7504
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Provider Business Mailing Address
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Address Line | 10 NICHOLLS ST
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City | DAVENPORT
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State | WA
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Zip | 99122-9729
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Country | US
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Telephone | 509-725-7501
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Fax | 509-725-7504
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Authorized Official
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Title or Position | CFO
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Name | TYSON LACY
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Credential |
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Telephone | 509-725-2979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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