Provider Demographics
NPI:1760582522
Name:PACIFIC COUNTY HOSPITAL DISTRICT 2
Entity Type:Organization
Organization Name:PACIFIC COUNTY HOSPITAL DISTRICT 2
Other - Org Name:WILLAPA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-875-5579
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:826 ALDER ST.
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0269
Mailing Address - Country:US
Mailing Address - Phone:360-875-5579
Mailing Address - Fax:360-875-5235
Practice Address - Street 1:826 ALDER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586-4900
Practice Address - Country:US
Practice Address - Phone:360-875-5579
Practice Address - Fax:360-875-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0317075OtherLABOR & INDUSTRIES-DR. BUBEN
WA9621491Medicaid
WA0317062OtherLABOR & INDUSTRIES-PFHC
WA0317067OtherLABOR & INDUSTRIES-JARED ABRAMS
WA1035732Medicaid
WAGAB11482OtherRENDERING PIN BUBEN
WAGAB11482OtherRENDERING PIN BUBEN
WA9621491Medicaid
WA503891Medicare Oscar/Certification
WA1035732Medicaid
WA0226098OtherLABOR & INDUSTRY MOSER
WAGAB11482OtherRENDERING PIN BUBEN
WAGAB11481Medicare ID - Type UnspecifiedMEDICARE NON RURAL HEALTH