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General NPI Number Information
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NPI Number | 1861813834
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Entity Type | Organization
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Legal Business Name | WASHINGTON STATE DEPARTMENT OF CORRECTIONS
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 7345 LINDERSON WAY SW
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City | TUMWATER
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State | WA
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Zip | 98501-6504
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Country | US
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Telephone | 360-725-8700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41100, MAIL STOP 41100
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City | OLYMPIA
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State | WA
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Zip | 98504-1100
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Country | US
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Telephone | 360-725-8213
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Fax |
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Authorized Official
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Title or Position | DEPUTY ASSISTANT SECRETARY
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Name | MR. MARK ROBERT ELIASON
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Credential | MBA
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Telephone | 360-485-1786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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