Provider Demographics
NPI:1063657377
Name:PUBLIC HOSPITAL DISTRIST NO. 1 OF SNOHOMISH COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRIST NO. 1 OF SNOHOMISH COUNTY
Other - Org Name:VALLEY GENERAL HOSPITAL WOUND CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-794-1447
Mailing Address - Street 1:14701 179TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1108
Mailing Address - Country:US
Mailing Address - Phone:360-794-1447
Mailing Address - Fax:360-794-1427
Practice Address - Street 1:14701 179TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1108
Practice Address - Country:US
Practice Address - Phone:360-794-1447
Practice Address - Fax:360-794-1427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HOSPITAL DISTRICT NO. 1 OF SNOHOMISH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-16
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001255800OtherMEDICARE PTAN#