Healthcare Provider Details

I. General information

NPI: 1619735925
Provider Name (Legal Business Name): ST. CHARLES HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20876 NE TRITON PL STE 110
BEND OR
97701-7319
US

IV. Provider business mailing address

20876 NE TRITON PL STE 110
BEND OR
97701-7319
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-3238
  • Fax: 541-797-5319
Mailing address:
  • Phone: 541-706-3238
  • Fax: 541-797-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATT SWAFFORD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 541-706-7707