Provider Demographics
NPI:1871822676
Name:PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Other - Org Name:OCEAN BEACH HOSPITAL AND CLINICS WOMEN'S HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-642-3181
Mailing Address - Street 1:167 1ST AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0000
Mailing Address - Country:US
Mailing Address - Phone:360-642-6498
Mailing Address - Fax:360-642-0114
Practice Address - Street 1:167 1ST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624-0319
Practice Address - Country:US
Practice Address - Phone:360-642-6498
Practice Address - Fax:360-642-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
508555Medicare Oscar/Certification