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General NPI Number Information
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NPI Number | 1255401683
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Entity Type | Organization
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Legal Business Name | GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO. 1
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 105 W SIMPSON AVE
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City | MCCLEARY
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State | WA
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Zip | 98557-9657
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Country | US
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Telephone | 360-346-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E. MAIN STREET
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City | ELMA
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State | WA
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Zip | 98541
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Country | US
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Telephone | 360-346-2222
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. RENEE K. JENSEN
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Credential |
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Telephone | 360-346-2222
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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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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | HAC.FS.00000186
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License Number State | WA
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