Provider Demographics
NPI:1053357244
Name:PUBLIC HOSPITAL DIST NO 1 SKAGIT
Entity type:Organization
Organization Name:PUBLIC HOSPITAL DIST NO 1 SKAGIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CESENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-445-8512
Mailing Address - Street 1:PO BOX 3548
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3548
Mailing Address - Country:US
Mailing Address - Phone:360-424-4111
Mailing Address - Fax:
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-424-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHAC.FS.00000207282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1001267Medicaid
WA0177741OtherLABOR & INDUSTRIES
WA1001267Medicaid