Provider Demographics
NPI:1467522896
Name:GRAYS HARBOR PUBLIC HOSPITAL DISTRICT NO 1
Entity Type:Organization
Organization Name:GRAYS HARBOR PUBLIC HOSPITAL DISTRICT NO 1
Other - Org Name:MARK REED HEALTHCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-346-2222
Mailing Address - Street 1:322 S BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:MCCLEARY
Mailing Address - State:WA
Mailing Address - Zip Code:98557-9522
Mailing Address - Country:US
Mailing Address - Phone:360-495-3500
Mailing Address - Fax:360-495-4423
Practice Address - Street 1:600 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-495-3500
Practice Address - Fax:360-495-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7104268Medicaid
WA7104268Medicaid
WAG000800088Medicare UPIN