MEDICARE: HIGH DESERT MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DC0535	OTHER	OR	RAILROD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	838331000	OTHER	OR	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447276837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH DESERT MEDICAL CENTER

Provider Business Mailing Address
First Line	:	559 W WASHINGTON ST
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-1441
Country	:	US
Telephone Number	:	541-573-2074
Fax Number	:	541-573-8893

Provider Business Practice Location Address
First Line	:	559 W WASHINGTON ST
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-1441
Country	:	US
Telephone Number	:	541-573-2074
Fax Number	:	541-573-8893

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. KEVIN JOHNSTON
Credential	:	MD
Telephone Number	:	541-573-2074

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	05/04/2012

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Directions to “HIGH DESERT MEDICAL CENTER ” Practice Location

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