Healthcare Provider Details

I. General information

NPI: 1144524273
Provider Name (Legal Business Name): ST. CHARLES HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NE NEFF RD
BEND OR
97701-6337
US

IV. Provider business mailing address

PO BOX 1420
REDMOND OR
97756-0400
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-3700
  • Fax: 541-706-3730
Mailing address:
  • Phone: 541-526-6556
  • Fax: 541-706-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN M SHEPARD
Title or Position: SR VP FINANCE / CFO
Credential:
Phone: 541-706-7707