Organization
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Active
Other names
South County Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE GLENN (CEO)
(360) 385-2200
Entity
Organization
Contact information
Practice address
294843 STATE HIGHWAY 101, QUILCENE, WA 98376
(360) 765-3111
(360) 765-3811
Mailing address
PO BOX 104546, PASADENA, CA 91189-4546
(360) 385-2200
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7056401
—
WA
Enumeration date
05/07/2007
Last updated
12/31/2025
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