Provider Demographics
NPI:1992827471
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:NORTH MASON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:APPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-427-9549
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0520
Mailing Address - Country:US
Mailing Address - Phone:360-427-3439
Mailing Address - Fax:360-427-9597
Practice Address - Street 1:140 NE STATE ROUTE 300
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-0520
Practice Address - Country:US
Practice Address - Phone:360-275-4084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA503989Medicare Oscar/Certification
WA00836Medicare UPIN