Provider Demographics
NPI:1275031304
Name:GRAYS HARBOR COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:GRAYS HARBOR COMMUNITY HOSPITAL
Other - Org Name:GHCH MONTESANO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:ANTONE
Authorized Official - Middle Name:J
Authorized Official - Last Name:EEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-581-5495
Mailing Address - Street 1:915 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1006
Mailing Address - Country:US
Mailing Address - Phone:360-537-4180
Mailing Address - Fax:
Practice Address - Street 1:319 E PIONEER AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-4601
Practice Address - Country:US
Practice Address - Phone:360-249-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA100366800Medicaid