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1935 E 19th St The Dalles OR 97058-3392 | |
(541) 506-6520 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1935 E 19th St, The Dalles, Oregon |
Authorized Official Name and Position | Dennis Knox (CORPORATE OFFICER CEO) |
Authorized Official Contact | 5412967273 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1520 The Dalles OR 97058 Ph: (541) 506-6520 | 1935 E 19th St The Dalles OR 97058-3392 Ph: (541) 506-6520 |
NPI Number | 1528383940 |
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Provider Enumeration Date | 03/29/2010 |
Last Update Date | 06/19/2023 |
Medicare PECOS PAC ID | 3779487251 |
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Medicare Enrollment ID | O20100929000632 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528383940 | NPI | - | NPPES |
500628255 | Medicaid | OR | |
2008485 | Medicaid | WA | |
500632165 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Oregon) | Primary |
Mid-columbia Health Service, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1700 E 19th St, The Dalles, OR 97058 Phone: 541-296-7760 Fax: 541-296-7619 | |
Columbia River Medical Clinic, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1615 E 12th St, Suite 100, The Dalles, OR 97058 Phone: 541-296-1919 Fax: 541-296-2253 |