Provider Demographics
NPI:1316411325
Name:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-678-7656
Mailing Address - Street 1:PO BOX 3603
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3603
Mailing Address - Country:US
Mailing Address - Phone:360-678-7656
Mailing Address - Fax:866-442-8884
Practice Address - Street 1:5632 W 63RD TERRACE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-4202
Practice Address - Country:US
Practice Address - Phone:360-678-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty