Healthcare Provider Details

I. General information

NPI: 1295974491
Provider Name (Legal Business Name): ST. CHARLES HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 12/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NE WYATT CT SUITE 103
BEND OR
97701-7702
US

IV. Provider business mailing address

PO BOX 1420
REDMOND OR
97756-0400
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4701
  • Fax: 541-706-4751
Mailing address:
  • Phone: 541-526-6556
  • Fax: 541-706-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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