Provider Demographics
NPI:1639109283
Name:PUBLIC HOSPITAL DIST NO 1 SKAGIT
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DIST NO 1 SKAGIT
Other - Org Name:SKAGIT REGIONAL CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:360-814-6724
Mailing Address - Street 1:1990 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9315
Mailing Address - Country:US
Mailing Address - Phone:360-856-4222
Mailing Address - Fax:
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty