Provider Demographics
NPI:1154361590
Name:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Entity type:Organization
Organization Name:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-678-7656
Mailing Address - Street 1:PO BOX 24789
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0789
Mailing Address - Country:US
Mailing Address - Phone:360-678-7656
Mailing Address - Fax:360-678-3858
Practice Address - Street 1:11245 SR 525
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236
Practice Address - Country:US
Practice Address - Phone:360-341-5252
Practice Address - Fax:360-341-8727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000092261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7105513Medicaid
WA508506Medicare Oscar/Certification