Provider Demographics
NPI:1396912754
Name:OKANOGAN DOUGLAS COUNTY HOSPITAL DISTRICT 1
Entity type:Organization
Organization Name:OKANOGAN DOUGLAS COUNTY HOSPITAL DISTRICT 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-689-2517
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:35 NORTH MAIN
Mailing Address - City:MANSFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98830-0158
Mailing Address - Country:US
Mailing Address - Phone:509-683-1300
Mailing Address - Fax:509-683-1313
Practice Address - Street 1:35 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:WA
Practice Address - Zip Code:98830-0158
Practice Address - Country:US
Practice Address - Phone:509-683-1300
Practice Address - Fax:509-683-1313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKANOGAN DOUGLAS COUNTY HOSPITAL DISTRICT 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-023261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center