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Organization

GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO. 1

Active
Parent organization
GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO. 1
Other names
Summit Pacific HealthCare Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO. 1
Authorized official
MRS. RENEE K JENSEN (CEO)
(360) 495-3244
Entity
Organization

Contact information

Practice address
600 E. MAIN STREET, ELMA, WA 98541
(360) 495-3244
Mailing address
600 E. MAIN STREET, ELMA, WA 98541

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
HAC.FS.00000186
WA
261QR1300X
Rural Health Clinic/Center
Primary
HAC.FS.00000186
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7103815
WA
01
AB18052
GROUP MEDICARE NUMBER
WA
Enumeration date
11/08/2012
Last updated
11/04/2013
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