Healthcare Provider Details

I. General information

NPI: 1598954562
Provider Name (Legal Business Name): CURRY HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 5TH ST
BROOKINGS OR
97415-9702
US

IV. Provider business mailing address

500 5TH STREET
BROOKINGS OR
97415
US

V. Phone/Fax

Practice location:
  • Phone: 541-412-2000
  • Fax: 541-412-2070
Mailing address:
  • Phone: 541-412-2000
  • Fax: 541-412-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD181844
License Number StateOR

VIII. Authorized Official

Name: SHELLIE R WILLCUTT
Title or Position: CREDENTIALING SPECIALIST
Credential: MD
Phone: 541-412-2073