1144496241 NPI number — SOUTH COUNTY HEALTH DISTRICT

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 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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