Basic Information
| Provider Information | |||||||||
| NPI: | 1164447850 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PUBLIC HOSPITAL DISTRICT NO 2 SKAGIT COUNTY WASHINGTON | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ISLAND HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 24TH ST | ||||||||
| Address2: | |||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602991350 | ||||||||
| FaxNumber: | 3602991369 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 24TH ST | ||||||||
| Address2: | |||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602991350 | ||||||||
| FaxNumber: | 3602991369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CUTTER | ||||||||
| AuthorizedOfficialFirstName: | ELISE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3602991301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H134 | WA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 8524SK | 01 | WA | REGENCE | OTHER | 9155102 | 05 | WA | MEDICAID | 8542IS | 01 | WA | REGENCE | OTHER | 0029980 | 01 | WA | LABOR & INDUSTRIES | OTHER | 7016926 | 05 | WA | MEDICAID |