1548344112 NPI number — COLUMBIA GORGE EDUCATION SERVICE DISTRICT

Table of content: (NPI 1548344112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548344112 NPI number — COLUMBIA GORGE EDUCATION SERVICE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA GORGE EDUCATION SERVICE 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:
REGION 9 EDUCATIONAL SERVICE DISTRICT
Provider Other Organization Name Type Code:
5
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:
1548344112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 EAST SCENIC DR
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
THE DALLES
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-298-5155
Provider Business Mailing Address Fax Number:
541-296-2965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1721 W 10TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-298-5155
Provider Business Practice Location Address Fax Number:
541-296-2965
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF STUDENT SERVICES
Authorized Official Telephone Number:
541-298-5156

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: #170131 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170131 . This is a "DMAP ID NO" identifier . This identifiers is of the category "OTHER".




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