Provider Demographics
NPI:1356439699
Name:PUBLIC HOPSITAL DISTRICT NO 1 OF MASON COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOPSITAL DISTRICT NO 1 OF MASON COUNTY
Other - Org Name:MASON HEALTH-OAKLAND BAY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-427-9554
Mailing Address - Street 1:PO BOX 1668
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584
Mailing Address - Country:US
Mailing Address - Phone:360-426-3102
Mailing Address - Fax:360-426-9866
Practice Address - Street 1:247 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-0011
Practice Address - Country:US
Practice Address - Phone:360-426-3102
Practice Address - Fax:360-426-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA508527Medicare Oscar/Certification
WAGAB22154Medicare UPIN