Provider Demographics
NPI:1700023405
Name:PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY
Other - Org Name:SHELTON ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:360-427-9554
Mailing Address - Street 1:939 MOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-4410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:939 MOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-4410
Practice Address - Country:US
Practice Address - Phone:360-427-9549
Practice Address - Fax:360-427-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000241100OtherGROUP MEDICARE PART B PTAN
WAG8896993Medicare PIN