Provider Demographics
NPI:1386679777
Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Entity Type:Organization
Organization Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Other - Org Name:ARBOR HEALTH SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-496-3647
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0019
Mailing Address - Country:US
Mailing Address - Phone:360-496-3504
Mailing Address - Fax:360-496-3508
Practice Address - Street 1:521 ADAMS AVENUE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98365
Practice Address - Country:US
Practice Address - Phone:360-496-3517
Practice Address - Fax:360-496-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH173207R00000X, 207Y00000X, 208600000X
WAH-173207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121064Medicaid
WA154384OtherLABOR & INDUSTRIES
WA501319Medicare Oscar/Certification
WA7121064Medicaid