1497797856 NPI number — HEALTHCARE FOR THE MID-COLUMBIA REGION

Table of content: (NPI 1497797856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497797856 NPI number — HEALTHCARE FOR THE MID-COLUMBIA REGION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE FOR THE MID-COLUMBIA REGION
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:
1497797856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4800
Provider Second Line Business Mailing Address:
UNIT 17
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 E 19TH ST
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:
97058-3317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-296-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARBON
Authorized Official First Name:
DON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
541-296-1111

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8906928 . This is a "WASHINGTON CRIME VICTIMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7128747 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD6600 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200123 . This is a "US DEPTARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 276307 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 865374000 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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