MEDICARE: PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WA

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1316174774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WA

Provider Business Mailing Address
First Line	:	1812 N 13TH LOOP RD
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 N 13TH LOOP RD STE A
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2169
Country	:	US
Telephone Number	:	360-426-2653
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ERIC MOLL
Credential	:	CEO
Telephone Number	:	360-427-9554

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	01/09/2026

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