1144496241 NPI number — SOUTH COUNTY HEALTH DISTRICT

Table of content: (NPI 1144496241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144496241 NPI number — SOUTH COUNTY HEALTH DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH COUNTY HEALTH DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELGIN FAMILY HEALTH CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144496241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 605
Provider Second Line Business Mailing Address:
142 EAST DEARBORN
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97883-0605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-562-6180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-437-6321
Provider Business Practice Location Address Fax Number:
541-437-8585
Provider Enumeration Date:
05/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MONTEE
Authorized Official First Name:
KIM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
541-562-6180

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  087000017N1 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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