Provider Demographics
NPI:1902074776
Name:PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
Other - Org Name:OCEAN BEACH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-642-6300
Mailing Address - Street 1:174 1ST AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0258
Mailing Address - Country:US
Mailing Address - Phone:360-642-3181
Mailing Address - Fax:360-642-6309
Practice Address - Street 1:174 1ST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624-0258
Practice Address - Country:US
Practice Address - Phone:360-642-3181
Practice Address - Fax:360-642-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHO79275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50Z314Medicare Oscar/Certification