Organization
GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Active
Other names
Summit Pacific Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENEE K JENSEN (CEO)
(360) 495-3244
Entity
Organization
Contact information
Practice address
600 E. MAIN STREET, ELMA, WA 98541
(360) 495-3244
(360) 495-4274
Mailing address
600 E. MAIN STREET, ELMA, WA 98541
(360) 495-3244
(360) 495-4274
Taxonomy
Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
Primary
H-186
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135
PREMERA
WA
01
—
18090
L&I ER DOC NUMBER
WA
01
—
18091
L&I ER FACILITY
WA
05
—
3147709
—
WA
05
—
7257108
—
WA
01
—
8903272
CRIME VICTIMS
WA
01
—
CD1667
RAILROAD MEDICARE
WA
01
—
G000800088
MEDICARE PRO FEE
WA
01
—
GR6577
REGENCE BLUE SHEILD
WA
01
—
QMXPR0048030
MOLINA H/O
WA
Enumeration date
04/04/2008
Last updated
01/24/2013
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