Provider Demographics
NPI:1528247632
Name:JEFFERSON COUNTY PUBLIC HOSPITAL DIST NO 2
Entity type:Organization
Organization Name:JEFFERSON COUNTY PUBLIC HOSPITAL DIST NO 2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALONA
Authorized Official - Middle Name:
Authorized Official - Last Name:COWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-385-6297
Mailing Address - Street 1:834 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2443
Mailing Address - Country:US
Mailing Address - Phone:360-385-2200
Mailing Address - Fax:360-379-2297
Practice Address - Street 1:1200 W SIMS WAY
Practice Address - Street 2:STE C
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-3031
Practice Address - Country:US
Practice Address - Phone:360-385-6297
Practice Address - Fax:360-385-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA183590OtherLABOR & INDUSTRIES
WA3443SEOtherREGENCE
WA8337412Medicaid
WA183590OtherLABOR & INDUSTRIES
WA8337412Medicaid