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General NPI Number Information
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NPI Number | 1093729329
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Entity Type | Organization
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Legal Business Name | WASHINGTON PARK MEDICAL CENTER, INC PS
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 208 CENTRALIA COLLEGE BLVD
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City | CENTRALIA
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State | WA
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Zip | 98531-4007
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Country | US
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Telephone | 360-736-0771
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Fax | 360-736-4867
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Provider Business Mailing Address
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Address Line | PO BOX 239
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City | CENTRALIA
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State | WA
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Zip | 98531-0239
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Country | US
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Telephone | 360-736-0771
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Fax | 360-736-4867
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Authorized Official
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Title or Position | PHYSICIAN
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Name | PAUL D WILLIAMS
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Credential | MD
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Telephone | 360-736-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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