1366168080 NPI number — UMPQUA COMMUNITY HEALTH CENTER, INC.

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 1366168080 NPI number — UMPQUA COMMUNITY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMPQUA COMMUNITY HEALTH CENTER, INC.
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:
1366168080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 NE KENNETH FORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470-1042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-672-9596
Provider Business Mailing Address Fax Number:
541-492-2060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 NE DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE CREEK
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97457-8507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-672-9596
Provider Business Practice Location Address Fax Number:
541-492-2060
Provider Enumeration Date:
10/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BOLTON
Authorized Official First Name:
KC
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
541-672-9596

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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