Organization
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Active
Other names
Ocean Beach Medical Group Ilwaco
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY COHEN (CEO)
(360) 642-6301
Entity
Organization
Contact information
Practice address
101 1ST AVE S, ILWACO, WA 98624-9100
(360) 642-2662
Mailing address
PO BOX N, ILWACO, WA 98624-0319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
H079
WA
261QR1300X
Rural Health Clinic/Center
Primary
H079
WA
363LF0000X
Family Nurse Practitioner
H079
WA
Other
Enumeration date
08/25/2015
Last updated
03/12/2019
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