Provider Demographics
NPI:1902975170
Name:PUBLIC HOSPITAL DISTRICT #3 SNOHOMISH COUNTY
Entity type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT #3 SNOHOMISH COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CE0
Authorized Official - Prefix:MR
Authorized Official - First Name:W.
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-435-2133
Mailing Address - Street 1:330 S STILLAGUAMISH AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1642
Mailing Address - Country:US
Mailing Address - Phone:360-435-2133
Mailing Address - Fax:360-403-4122
Practice Address - Street 1:9109 271ST ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-5999
Practice Address - Country:US
Practice Address - Phone:360-435-7374
Practice Address - Fax:360-435-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043355204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB8806163Medicare ID - Type Unspecified
WAI15851Medicare UPIN