Organization
LINCOLN COUNTY HOSPITAL DISTRICT 3
Active
Other names
North Basin Medical Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
TYSON LACY (CFO)
(509) 725-2979
Entity
Organization
Contact information
Practice address
10 NICHOLLS ST, DAVENPORT, WA 99122-9729
(509) 725-7501
(509) 725-7504
Mailing address
10 NICHOLLS ST, DAVENPORT, WA 99122-9729
(509) 725-7501
(509) 725-7504
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7101132
—
WA
05
—
7117450
—
WA
01
—
CJ6525
MEDICARE RAILROAD
WA
Enumeration date
05/16/2007
Last updated
07/07/2022
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