Provider Demographics
NPI:1184776916
Name:FERRY COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity type:Organization
Organization Name:FERRY COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFI
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-445-3333
Mailing Address - Street 1:36 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9701
Mailing Address - Country:US
Mailing Address - Phone:509-775-3153
Mailing Address - Fax:509-775-8929
Practice Address - Street 1:10 ROS CIRCLE
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-9701
Practice Address - Country:US
Practice Address - Phone:509-775-3153
Practice Address - Fax:509-775-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7113970Medicaid
WA7033210Medicaid
WA7033210Medicaid
WA50-8522Medicare ID - Type UnspecifiedRURAL HEALTH