Provider Demographics
NPI:1518119403
Name:CLALLAM COUNTY JAIL MEDICAL
Entity Type:Organization
Organization Name:CLALLAM COUNTY JAIL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-417-2592
Mailing Address - Street 1:223 E 4TH ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3000
Mailing Address - Country:US
Mailing Address - Phone:360-417-2592
Mailing Address - Fax:
Practice Address - Street 1:223 E 4TH ST
Practice Address - Street 2:SUITE 12
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3000
Practice Address - Country:US
Practice Address - Phone:360-417-2592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare