Provider Demographics
NPI:1588717250
Name:PUBLIC HOSPITAL DISTRICT 2 OF SNOHOMISH COUNTY
Entity type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT 2 OF SNOHOMISH COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-640-4951
Mailing Address - Street 1:21911 76TH AVE W
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7903
Mailing Address - Country:US
Mailing Address - Phone:425-640-4950
Mailing Address - Fax:425-640-4958
Practice Address - Street 1:21911 76TH AVE W
Practice Address - Street 2:SUITE 110
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7903
Practice Address - Country:US
Practice Address - Phone:425-640-4950
Practice Address - Fax:425-640-4958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHD2 OF SNOHOMISH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA312 003 974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7060742Medicaid
WA51069OtherL & I
WAC46531OtherMEDICARE RAILROAD
WA51069OtherL & I
WA115108200Medicare ID - Type Unspecified