MEDICARE: PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1790013373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON

Provider Business Mailing Address
First Line	:	1812 N 13TH LOOP RD
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2169
Country	:	US
Telephone Number	:	360-427-0366
Fax Number	:	360-427-5879

Provider Business Practice Location Address
First Line	:	1812 N 13TH LOOP RD
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2169
Country	:	US
Telephone Number	:	360-427-0366
Fax Number	:	360-427-5879

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

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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