Provider Demographics
NPI:1629012463
Name:PUBLIC HOSPITAL DIST NO 1 SKAGIT
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DIST NO 1 SKAGIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHIZUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-814-5838
Mailing Address - Street 1:307 S 13TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4100
Mailing Address - Country:US
Mailing Address - Phone:360-814-2146
Mailing Address - Fax:360-428-2445
Practice Address - Street 1:307 S 13TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4100
Practice Address - Country:US
Practice Address - Phone:360-814-2146
Practice Address - Fax:360-428-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-073174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1014836Medicaid
WA1014836Medicaid