MEDICARE: WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1982116901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	275 SE CABOT DR STE B101
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3740
Country	:	US
Telephone Number	:	360-675-6648
Fax Number	:	360-679-2487

Provider Business Practice Location Address
First Line	:	275 SE CABOT DR STE B101
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3740
Country	:	US
Telephone Number	:	360-675-6648
Fax Number	:	360-679-2487

Authorized Official
Title or Position	:	COO
Name	:	GARTH MILLER
Credential	:
Telephone Number	:	360-678-7656

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	07/20/2023

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