Organization
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Active
Other names
Jefferson Healthcare Surgical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE GLENN (CEO)
(360) 385-2200
Entity
Organization
Contact information
Practice address
1010 SHERIDAN ST STE 201, PORT TOWNSEND, WA 98368-2901
(360) 385-5444
(360) 385-5352
Mailing address
PO BOX 104546, PASADENA, CA 91189-4546
(360) 385-2200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
282NC0060X
Critical Access Hospital
Primary
HAC.FS.00000085
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008579
—
WA
05
—
3301900
—
WA
Enumeration date
02/12/2014
Last updated
12/31/2025
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