Basic Information
| Provider Information | |||||||||
| NPI: | 1043497001 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WHIDBEY GENERAL HOSPITAL MEDICAL ONCOLOGY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3603 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981243603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606785151 | ||||||||
| FaxNumber: | 3606787676 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COUPEVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982393413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606785151 | ||||||||
| FaxNumber: | 3606787676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 04/28/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VESSEY | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3606787656 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 364SA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.