Provider Demographics
NPI:1821138983
Name:PUBLIC HOSP DISTRICT #2 OF SNOH COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSP DISTRICT #2 OF SNOH COUNTY
Other - Org Name:CENTER FOR WOUND HEALING & HYPERBARICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-673-3374
Mailing Address - Street 1:PO BOX 91000
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-2100
Mailing Address - Country:US
Mailing Address - Phone:425-673-3374
Mailing Address - Fax:425-640-4455
Practice Address - Street 1:21911 76TH AVE W STE 204
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7918
Practice Address - Country:US
Practice Address - Phone:425-673-3380
Practice Address - Fax:425-673-3382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HOSP DISTRICT #2 OF SNOH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB39462Medicare PIN