Basic Information
Provider Information | |||||||||
NPI: | 1710913140 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PUBLIC HOSPITAL DISTRICT NO 2 SKAGIT COUNTY WASHINGTON | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ISLAND HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1211 24TH ST | ||||||||
Address2: |   | ||||||||
City: | ANACORTES | ||||||||
State: | WA | ||||||||
PostalCode: | 982212557 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3602991300 | ||||||||
FaxNumber: | 3602991339 | ||||||||
Practice Location | |||||||||
Address1: | 1211 24TH ST | ||||||||
Address2: |   | ||||||||
City: | ANACORTES | ||||||||
State: | WA | ||||||||
PostalCode: | 982212557 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3602991300 | ||||||||
FaxNumber: | 3602991339 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2006 | ||||||||
LastUpdateDate: | 01/25/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CUTTER | ||||||||
AuthorizedOfficialFirstName: | ELISE | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
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 | 10583 | 01 | WA | LABOR & INDUSTRIES | OTHER | 146 | 01 | WA | BLUE CROSS | OTHER | 3341302 | 05 | WA |   | MEDICAID | 9999IS | 01 | WA | REGENCE | OTHER | 025131147 | 01 | WA | GROUP HEALTH | OTHER | 15685 | 01 | WA | REGENCE | OTHER |