=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619778164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF HOQUIAM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2025
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 10TH STREET
-----------------------------------------------------
City | HOQUIAM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98550-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-532-0892
-----------------------------------------------------
Fax | 360-532-0899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 10TH STREET
-----------------------------------------------------
City | HOQUIAM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98550-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-532-0892
-----------------------------------------------------
Fax | 360-532-0899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MAYOR OF HOQUIAM
-----------------------------------------------------
Name | BEN WINKLEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-538-3971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2400X
-----------------------------------------------------
Taxonomy Name | Prison Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------