Provider Demographics
NPI:1235213034
Name:CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity Type:Organization
Organization Name:CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Other - Org Name:CLALLAM BAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-374-6271
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:CLALLAM BAY
Mailing Address - State:WA
Mailing Address - Zip Code:98326
Mailing Address - Country:US
Mailing Address - Phone:360-374-6271
Mailing Address - Fax:360-374-9781
Practice Address - Street 1:74 BOGACHIEL ST
Practice Address - Street 2:
Practice Address - City:CLALLAM BAY
Practice Address - State:WA
Practice Address - Zip Code:98326
Practice Address - Country:US
Practice Address - Phone:360-963-2202
Practice Address - Fax:360-374-9781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-054261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7102122Medicaid
WA7105315Medicaid
WA503975Medicare Oscar/Certification