Provider Demographics
NPI:1053527853
Name:LINCOLN COUNTY HOSPITAL DISTRICT 3
Entity type:Organization
Organization Name:LINCOLN COUNTY HOSPITAL DISTRICT 3
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-725-2979
Mailing Address - Street 1:10 NICHOLLS ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9729
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:10 NICHOLLS ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9729
Practice Address - Country:US
Practice Address - Phone:509-725-7501
Practice Address - Fax:509-725-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117450Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA7101132Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA508530Medicare Oscar/Certification
WA7117450Medicaid
WA508529Medicare Oscar/Certification
WAGAB16799Medicare PIN