Provider Demographics
NPI:1700111986
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:MASON GENERAL HOSPITAL FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:APPEL
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:360-427-9556
Mailing Address - Street 1:1812 N 13TH LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2169
Mailing Address - Country:US
Mailing Address - Phone:360-426-3862
Mailing Address - Fax:360-427-1743
Practice Address - Street 1:1812 N 13TH LOOP RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2169
Practice Address - Country:US
Practice Address - Phone:360-426-3862
Practice Address - Fax:360-427-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001087207Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8886398Medicare PIN