NPIMap

Organization Active NPI

Public Hospital District #1

  • Specialist
  • Mount Vernon, WA
National Provider Identifier
1104990985
Registry record updated Dec 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
H-207 Issued in WA
Legal business name
PUBLIC HOSPITAL DISTRICT #1
Practice address
1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone
(360) 424-4111
NPI assigned
Nov 20, 2006
Last updated
Dec 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2017

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) 814-5838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X H-207 WA Primary

Addresses

Primary practice location

1415 E Kincaid St
Mount Vernon, WA 98274-4126

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7099377MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Public Hospital District No26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

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": "1512604800000",
    "number": "1104990985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "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": "1415 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-424-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT #1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2017-12-07",
        "status": "A",
        "authorized_official_last_name": "ISHIZUKA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-814-5838"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "H-207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7099377",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 7, 2017; 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.