Provider Demographics
NPI:1720121650
Name:GRAYS HARBOR COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:GRAYS HARBOR COMMUNITY HOSPITAL
Other - Org Name:GRAYS HARBOR HOUSE ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:VESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-537-5145
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:1006 N H STREET
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520
Mailing Address - Country:US
Mailing Address - Phone:360-537-6120
Mailing Address - Fax:360-537-6146
Practice Address - Street 1:915 ANDERSON DRIVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520
Practice Address - Country:US
Practice Address - Phone:360-532-8330
Practice Address - Fax:360-537-6146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYS HARBOR COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207L00000X, 282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7108418Medicaid
WA000860100Medicare ID - Type Unspecified