Provider Demographics
NPI:1528142320
Name:CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity type:Organization
Organization Name:CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COURNYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-374-6271
Mailing Address - Street 1:530 BOGACHIEL WAY
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331
Mailing Address - Country:US
Mailing Address - Phone:360-374-6271
Mailing Address - Fax:360-374-9781
Practice Address - Street 1:530 BOGACHIEL WAY
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9120
Practice Address - Country:US
Practice Address - Phone:360-374-6271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-054282NC0060X
WA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4205407Medicaid
WA50Z325Medicare Oscar/Certification