Provider Demographics
NPI:1356305395
Name:OKANOGAN DOUGLAS COUNTY HOSPITAL DIST 1
Entity Type:Organization
Organization Name:OKANOGAN DOUGLAS COUNTY HOSPITAL DIST 1
Other - Org Name:THREE RIVERS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-689-2517
Mailing Address - Street 1:507 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-0577
Mailing Address - Country:US
Mailing Address - Phone:509-689-2517
Mailing Address - Fax:509-689-2086
Practice Address - Street 1:507 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-0507
Practice Address - Country:US
Practice Address - Phone:509-689-2517
Practice Address - Fax:509-689-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1356305395Medicaid
WA1356305395Medicaid
WA501324Medicare ID - Type Unspecified