Provider Demographics
NPI:1598704769
Name:PUBLIC HOSPITAL DISTRICT #3 SNOHOMISH COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT #3 SNOHOMISH COUNTY
Other - Org Name:CASCADE VALLEY SMOKEY POINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-435-2133
Mailing Address - Street 1:330 S STILLAGUAMISH AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1642
Mailing Address - Country:US
Mailing Address - Phone:360-435-2133
Mailing Address - Fax:360-435-0513
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-653-4569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7073794Medicaid
WAAB06351Medicare PIN