Provider Demographics
NPI:1467497636
Name:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Other - Org Name:WHIDBEYHEALTH PRIMARY CARE-GOLDIE ST.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-678-7656
Mailing Address - Street 1:PO BOX 24789
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0789
Mailing Address - Country:US
Mailing Address - Phone:360-678-7656
Mailing Address - Fax:360-678-3858
Practice Address - Street 1:1300 NE GOLDIE ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4832
Practice Address - Country:US
Practice Address - Phone:360-679-5590
Practice Address - Fax:360-240-4029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000092261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7105422Medicaid
WA503996Medicare Oscar/Certification