1982692372 NPI number — SHERMAN COUNTY HEALTH DISTRICT

Table of content: (NPI 1982692372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982692372 NPI number — SHERMAN COUNTY HEALTH DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERMAN 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:
SHERMAN COUNTY MEDICAL 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:
1982692372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97039-0186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-565-0536
Provider Business Mailing Address Fax Number:
541-565-3617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97039-3080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-565-0536
Provider Business Practice Location Address Fax Number:
541-565-3617
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLAGG
Authorized Official First Name:
CAITLIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DISTRICT ADMINISTRATOR
Authorized Official Telephone Number:
541-565-0536

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 165028 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383820 . This is a "MEDICARE-PTAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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