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General NPI Number Information
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NPI Number | 1467522896
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Entity Type | Organization
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Legal Business Name | GRAYS HARBOR 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 | 10/02/2014
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Provider Practice Location 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 | 360-495-3500
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Fax | 360-495-4423
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Provider Business Mailing Address
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Address Line | 322 S BIRCH ST
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City | MCCLEARY
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State | WA
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Zip | 98557-9522
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Country | US
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Telephone | 360-495-3500
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Fax | 360-495-4423
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Authorized Official
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Title or Position | CEO
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Name | MS. 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 | WA
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