Provider Demographics
NPI:1841234598
Name:LINCOLN COUNTY HOSPITAL DISTRICT 3
Entity Type:Organization
Organization Name:LINCOLN COUNTY HOSPITAL DISTRICT 3
Other - Org Name:LINCOLN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:E
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-725-2979
Mailing Address - Street 1:10 NICHOLLS ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9729
Mailing Address - Country:US
Mailing Address - Phone:509-725-7101
Mailing Address - Fax:509-725-2112
Practice Address - Street 1:10 NICHOLLS ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9729
Practice Address - Country:US
Practice Address - Phone:509-725-7101
Practice Address - Fax:509-725-2112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN COUNTY HOSPITAL DISTRICT #3
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-137282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117450Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA7101132Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA7101132Medicaid
WA501305Medicare Oscar/Certification