=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316347255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASON GENERAL HOSPITAL AND FAMILY OF CLINICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2014
-----------------------------------------------------
Last Update Date | 08/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 MOUNTAIN VIEW DR
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98584-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-427-3654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 MOUNTAIN VIEW DR PO BOX 1668
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98584-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-427-3654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | DR. NICOLE EDDINS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 360-427-3654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | PH60008883
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------