Healthcare Provider Details

I. General information

NPI: 1023056017
Provider Name (Legal Business Name): DESCHUTES COUNTY OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 NE COURTNEY DR
BEND OR
97701-7638
US

IV. Provider business mailing address

2577 NE COURTNEY DR
BEND OR
97701-7638
US

V. Phone/Fax

Practice location:
  • Phone: 541-322-7400
  • Fax: 541-322-7465
Mailing address:
  • Phone: 541-322-7400
  • Fax: 541-322-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number042981
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number030805147
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number261QP0905X
License Number StateOR

VIII. Authorized Official

Name: DAVID GERARD INBODY
Title or Position: HEALTH SERVICES DEPUTY DIRECTOR
Credential:
Phone: 541-322-7678