Provider Demographics
NPI:1902001381
Name:JEFFERSON COUNTY HEALTH SERVICES DISTRICT NO 2
Entity Type:Organization
Organization Name:JEFFERSON COUNTY HEALTH SERVICES DISTRICT NO 2
Other - Org Name:DR. LYNN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTRATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-385-2200
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0001
Mailing Address - Country:US
Mailing Address - Phone:360-385-5330
Mailing Address - Fax:
Practice Address - Street 1:1136 WATER ST STE 107
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6728
Practice Address - Country:US
Practice Address - Phone:360-385-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1079144Medicaid
WA1079144Medicaid