Provider Demographics
NPI:1689965063
Name:WASHINGTON STATE DEPARTMENT OF CORRECTIONS MISSION CREEK CORRECTIONS C
Entity type:Organization
Organization Name:WASHINGTON STATE DEPARTMENT OF CORRECTIONS MISSION CREEK CORRECTIONS C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CURL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-318-3498
Mailing Address - Street 1:PO BOX 41100, MAIL STOP 41100
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-1100
Mailing Address - Country:US
Mailing Address - Phone:360-725-8213
Mailing Address - Fax:360-586-1320
Practice Address - Street 1:3420 NE SAND HILL ROAD
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528
Practice Address - Country:US
Practice Address - Phone:360-277-2400
Practice Address - Fax:360-277-2454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF CORRECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health