Provider Demographics
NPI:1194032201
Name:JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Entity Type:Organization
Organization Name:JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Other - Org Name:JEFFERSON HEALTHCARE WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTRATION COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:CHAM
Authorized Official - Phone:360-385-2200
Mailing Address - Street 1:834 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2443
Mailing Address - Country:US
Mailing Address - Phone:360-385-2200
Mailing Address - Fax:360-379-2282
Practice Address - Street 1:1274 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2404
Practice Address - Country:US
Practice Address - Phone:360-379-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-10
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHAC.FS.00000085363AM0700X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty