Provider Demographics
NPI:1295771376
Name:PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Entity type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-642-3181
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0258
Mailing Address - Country:US
Mailing Address - Phone:360-642-3181
Mailing Address - Fax:360-642-6309
Practice Address - Street 1:174 1ST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624-0258
Practice Address - Country:US
Practice Address - Phone:360-642-3181
Practice Address - Fax:360-642-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-079261QC0050X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMT0804OtherDOH MED. TEST LICENSE
WAH-079OtherSTATE OF WA DOH LICENSE
WA3627502Medicaid
WAMT0804OtherDOH MED. TEST LICENSE