MEDICARE: ST. CHARLES HEALTH SYSTEM, INC.

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	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1629889902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. CHARLES HEALTH SYSTEM, INC.

Provider Business Mailing Address
First Line	:	PO BOX 6095
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97708-6095
Country	:	US
Telephone Number	:	541-382-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 NW SHEVLIN PARK RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7195
Country	:	US
Telephone Number	:	541-382-3344
Fax Number	:	541-382-1681

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MATTHEW SWAFFORD
Credential	:
Telephone Number	:	541-382-4321

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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