Provider Demographics
NPI:1467581678
Name:COUNTY OF ISLAND
Entity Type:Organization
Organization Name:COUNTY OF ISLAND
Other - Org Name:ISLAND COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-240-5575
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-5000
Mailing Address - Country:US
Mailing Address - Phone:360-679-7351
Mailing Address - Fax:360-679-7347
Practice Address - Street 1:410 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-5000
Practice Address - Country:US
Practice Address - Phone:360-679-7351
Practice Address - Fax:360-679-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8017741Medicaid
WA7046493Medicaid
WA7400724Medicaid
WAG001100809Medicare PIN