MEDICARE: PUBLIC HOSPITAL DISTRICT NO 1 SKAGIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	HAC.FS.0000106	WA
2	208000000X	Pediatrics Physician	HAC.FS.00000106	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043241540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HOSPITAL DISTRICT NO 1 SKAGIT

Provider Business Mailing Address
First Line	:	PO BOX 103510
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91189-3570
Country	:	US
Telephone Number	:	360-814-7575
Fax Number	:	360-445-8592

Provider Business Practice Location Address
First Line	:	875 WESLEY ST
Second Line	:	STE 130
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1613
Country	:	US
Telephone Number	:	360-435-6525
Fax Number	:	360-435-2634

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	TAMARA CESENA
Credential	:
Telephone Number	:	360-445-8512

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/30/2025

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