1023117751 NPI number — ST. CHARLES HEALTH SYSTEM, INC.

Table of content: (NPI 1023117751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023117751 NPI number — ST. CHARLES HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CHARLES HEALTH SYSTEM, 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:
6
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:
1023117751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97708-5579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-516-3866
Provider Business Mailing Address Fax Number:
541-516-3877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2042 NE WILLIAMSON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701-3760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-706-6905
Provider Business Practice Location Address Fax Number:
541-706-6906
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPARD
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR VP FINANCE / CFO
Authorized Official Telephone Number:
541-706-7707

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500625168 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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