NPIMap

Organization Active NPI

Public Hospital Dist No 1 Skagit

Doing business as Skagit Valley Kidney Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Mount Vernon, WA
National Provider Identifier
1093889875
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
H-207 Issued in WA
Legal business name
PUBLIC HOSPITAL DIST NO 1 SKAGIT
Doing business as
Skagit Valley Kidney Center
Practice address
208 S. Hospital Parkway
Mount Vernon, WA 98274-4126
Phone
(360) 424-4111
NPI assigned
Nov 20, 2006
Last updated
Sep 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Ishizuka
Title
Cfo
Phone
(360) 814-8346

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X H-207 WA Primary

Addresses

Primary practice location

208 S. Hospital Parkway
Mount Vernon, WA 98274-4126

Mailing address

1415 E Kincaid St
Attn: Credentialing
Mount Vernon, WA 98274-4126
Phone (360) 424-4111

Other identifiers 1

IdentifierTypeStateIssuer
1002366MedicaidWA

Other names 1

  • Skagit Valley Kidney Center Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537228800000",
    "number": "1093889875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-424-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 S. HOSPITAL PARKWAY",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-424-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DIST NO 1 SKAGIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2018-09-18",
        "status": "A",
        "authorized_official_last_name": "ISHIZUKA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-814-8346"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "WA",
            "license": "H-207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002366",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skagit Valley Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.