1487685004 NPI number — MORROW COUNTY HEALTH DISTRICT

Table of content: (NPI 1487685004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487685004 NPI number — MORROW COUNTY HEALTH DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORROW 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:
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:
1487685004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEPPNER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97836-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-676-5504
Provider Business Mailing Address Fax Number:
541-676-9025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 THOMPSON AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEPPNER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-676-5504
Provider Business Practice Location Address Fax Number:
541-676-9025
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAHONEY
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
541-676-5504

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  141444 , 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)

  • Identifier: 168725 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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