Provider Demographics
NPI:1295708683
Name:PACIFIC COUNTY HOSPITAL DISTRICT 2
Entity type:Organization
Organization Name:PACIFIC COUNTY HOSPITAL DISTRICT 2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-875-4508
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:800 ALDER ST
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586
Mailing Address - Country:US
Mailing Address - Phone:360-875-5526
Mailing Address - Fax:360-875-6167
Practice Address - Street 1:800 ALDER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586
Practice Address - Country:US
Practice Address - Phone:360-875-5526
Practice Address - Fax:360-875-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3300308Medicaid
WA3300308Medicaid