Provider Demographics
NPI:1649324674
Name:LEWIS COUNTY HOSPITAL DIST #1
Entity type:Organization
Organization Name:LEWIS COUNTY HOSPITAL DIST #1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COURNYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-496-3701
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:MOSSYROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98564-0508
Mailing Address - Country:US
Mailing Address - Phone:360-496-3702
Mailing Address - Fax:360-983-3098
Practice Address - Street 1:521 ADAMS AVENUE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-496-5112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH173261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7135205Medicaid