1164428066 NPI number — WALLOWA COUNTY HEALTH CARE DISTRICT

Table of content: (NPI 1164428066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164428066 NPI number — WALLOWA COUNTY HEALTH CARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALLOWA COUNTY HEALTH CARE 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:
WALLOWA MEMORIAL HOSPITAL-SWINGBED
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:
1164428066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 MEDICAL PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENTERPRISE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97828-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-426-3111
Provider Business Mailing Address Fax Number:
541-426-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 MEDICAL PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENTERPRISE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97828-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-426-3111
Provider Business Practice Location Address Fax Number:
541-426-1901
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WANNER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
541-426-5460

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  14 0068 , 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)

  • Identifier: 214205 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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