Provider Demographics
NPI:1255616579
Name:HARRISON MEDICAL CENTER
Entity type:Organization
Organization Name:HARRISON MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-744-6505
Mailing Address - Street 1:461 G ST
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-9025
Mailing Address - Country:US
Mailing Address - Phone:360-374-6224
Mailing Address - Fax:360-374-6039
Practice Address - Street 1:461 G ST
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9025
Practice Address - Country:US
Practice Address - Phone:360-374-6224
Practice Address - Fax:360-374-6039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRISON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-18
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020155Medicaid
WA287849OtherLABOR AND INDUSTRIES
WA503824Medicare Oscar/Certification