Provider Demographics
NPI:1053467712
Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Entity Type:Organization
Organization Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Other - Org Name:ANESTHESIA GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-496-3701
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0019
Mailing Address - Country:US
Mailing Address - Phone:360-496-5112
Mailing Address - Fax:360-983-3098
Practice Address - Street 1:521 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-496-5112
Practice Address - Fax:360-496-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9650805Medicaid