NPIMap

Organization Active NPI

Pacific County Hospital District #2

Doing business as Southbend Clinic

  • Family Medicine Physician
  • South Bend, WA
National Provider Identifier
1982761904
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PACIFIC COUNTY HOSPITAL DISTRICT #2
Doing business as
Southbend Clinic
Practice address
800 Alder Street
Southbend, WA 98586
Phone
(360) 875-5339
Fax
(360) 875-6167
NPI assigned
Jan 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Terry Stone
Title
Cfo
Phone
(360) 875-4508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

800 Alder Street
Southbend, WA 98586

Mailing address

PO Box 1370
800 Alder Street
Southbend, WA 98586
Phone (360) 875-5339

Other identifiers 1

IdentifierTypeStateIssuer
7102957MedicaidWA

Other names 1

  • Southbend Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clinic Graylandwilla3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982761904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1370",
            "address_2": "800 ALDER STREET",
            "city": "SOUTHBEND",
            "state": "WA",
            "postal_code": "98586",
            "telephone_number": "360-875-5339",
            "fax_number": "360-875-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ALDER STREET",
            "city": "SOUTHBEND",
            "state": "WA",
            "postal_code": "98586",
            "telephone_number": "360-875-5339",
            "fax_number": "360-875-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC COUNTY HOSPITAL DISTRICT #2",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-875-4508",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7102957",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southbend Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.