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1825 E 19th St Suite 3 The Dalles OR 97058-3365 | |
(509) 493-1467 | |
(509) 493-3765 |
Full Name | |
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Speciality | Internal Medicine - Infectious Disease |
Location | 1825 E 19th St, The Dalles, Oregon |
Authorized Official Name and Position | Thomas J Nichol (OPERATING MANAGER) |
Authorized Official Contact | 5094931467 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1825 E 19th St Suite 3 The Dalles OR 97058-3365 Ph: (509) 493-1467 | 1825 E 19th St Suite 3 The Dalles OR 97058-3365 Ph: (509) 493-1467 |
NPI Number | 1790833721 |
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Provider Enumeration Date | 01/08/2007 |
Last Update Date | 09/05/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790833721 | NPI | - | NPPES |
002415 | Medicaid | OR | |
1059047 | Other | WA | WASHINGTON MEDICAID |
K285401 | Other | OR | PACIFIC SOURCE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | MD16255 (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 |