Provider Demographics
NPI:1861813834
Name:WA STATE DEPARTMENT OF CORRECTIONS HEADQUARTERS
Entity Type:Organization
Organization Name:WA STATE DEPARTMENT OF CORRECTIONS HEADQUARTERS
Other - Org Name:DOC HQ HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:G.
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-725-8700
Mailing Address - Street 1:PO BOX 41123
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-1123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7345 LINDERSON WAY SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6504
Practice Address - Country:US
Practice Address - Phone:360-725-8709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health