Provider Demographics
NPI:1154361814
Name:LEWIS COUNTY HOSPITAL DISTRICT NO 1
Entity type:Organization
Organization Name:LEWIS COUNTY HOSPITAL DISTRICT NO 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-496-3525
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0019
Mailing Address - Country:US
Mailing Address - Phone:360-496-5112
Mailing Address - Fax:360-496-3508
Practice Address - Street 1:521 ADAMS AVENUE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-496-5112
Practice Address - Fax:360-496-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-173282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0005476OtherLABOR & IND FACILITY
037922800OtherFEDERAL BLACK LUNG
WA3081601Medicaid
WA3081601Medicaid