Provider Demographics
NPI:1922196609
Name:PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY WASHINGTON
Other - Org Name:MASON COUNTY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:APPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-427-9556
Mailing Address - Street 1:2300 KATI CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-1900
Mailing Address - Country:US
Mailing Address - Phone:360-426-8717
Mailing Address - Fax:
Practice Address - Street 1:2300 KATI CT
Practice Address - Street 2:SUITE C
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-1926
Practice Address - Country:US
Practice Address - Phone:360-426-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA152W00000X, 207W00000X
261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000241100Medicare PIN