1124917349 NPI number — CHRIS HUMPHREYS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124917349 NPI number — CHRIS HUMPHREYS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRIS HUMPHREYS LLC
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:
Provider Other Organization Name Type Code:
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:
1124917349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 LAKEVIEW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEPPNER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97836-6389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-708-2891
Provider Business Mailing Address Fax Number:
541-429-4118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SOUTHGATE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-3971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-215-4440
Provider Business Practice Location Address Fax Number:
541-429-4118
Provider Enumeration Date:
07/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
HUMPHREYS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
PRACTICE OWNER
Authorized Official Telephone Number:
503-708-2891

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500771872 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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