Provider Demographics
NPI:1740211028
Name:GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity Type:Organization
Organization Name:GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Other - Org Name:SUMMIT PACIFIC MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-346-2222
Mailing Address - Street 1:600 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541
Mailing Address - Country:US
Mailing Address - Phone:360-495-3244
Mailing Address - Fax:360-495-4274
Practice Address - Street 1:600 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-495-3244
Practice Address - Fax:360-495-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA18090OtherL&I ER DOC NUMBER
WA18091OtherL&I ER FACILITY NUMBER
WA7257108Medicaid
WA3147709Medicaid
WA8918276OtherCRIME VICTIM PRO FEE
WA8903273OtherCRIME VICTIMS
WA135OtherPREMERA
WAGR6577OtherREGENCE BLUE SHIELD
WAQMXPR0048030OtherMOLINA H/O
WA7257108Medicaid
WA8918276OtherCRIME VICTIM PRO FEE
WAG000800088Medicare ID - Type UnspecifiedMEDICARE PRO FEE
WA3147709Medicaid