Provider Demographics
NPI:1689604563
Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Entity Type:Organization
Organization Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Other - Org Name:ARBOR HEALTH RANDLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-496-5112
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0019
Mailing Address - Country:US
Mailing Address - Phone:360-496-5112
Mailing Address - Fax:360-496-3504
Practice Address - Street 1:108 KINDLE ROAD
Practice Address - Street 2:
Practice Address - City:RANDLE
Practice Address - State:WA
Practice Address - Zip Code:98377
Practice Address - Country:US
Practice Address - Phone:360-497-3333
Practice Address - Fax:360-497-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH173261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7111230Medicaid
WADB0062OtherRAILROAD MEDICARE
WA508511Medicare ID - Type UnspecifiedRANDLE CLINIC RURAL HEALT