Healthcare Provider Details

I. General information

NPI: 1053422139
Provider Name (Legal Business Name): COUNTY OF BAKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 4TH ST
BAKER CITY OR
97814-2615
US

IV. Provider business mailing address

2200 4TH ST
BAKER CITY OR
97814-2615
US

V. Phone/Fax

Practice location:
  • Phone: 541-523-8211
  • Fax: 541-523-8242
Mailing address:
  • Phone: 541-523-8211
  • Fax: 541-523-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier097410
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
IdentifierR166882
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE PTAN
# 3
Identifier320390
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 4
Identifier045315
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 5
Identifier226312
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: NANCY STATEN
Title or Position: DIRECTOR
Credential:
Phone: 541-523-8211