Provider Demographics
NPI:1730309824
Name:CLARK COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:CLARK COUNTY PUBLIC HEALTH
Other - Org Name:CLARK COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:564-397-8475
Mailing Address - Street 1:PO BOX 9825
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-8825
Mailing Address - Country:US
Mailing Address - Phone:360-397-8473
Mailing Address - Fax:360-397-8110
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD BLDG 17
Practice Address - Street 2:3RD FLOOR
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:360-397-8473
Practice Address - Fax:360-397-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7400682Medicaid