Healthcare Provider Details

I. General information

NPI: 1225291503
Provider Name (Legal Business Name): KLAMATH HEALTH PARTNERSHIP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WASCO AVE
CHILOQUIN OR
97624
US

IV. Provider business mailing address

2074 SOUTH 6TH STREET
KLAMATH FALLS OR
97601
US

V. Phone/Fax

Practice location:
  • Phone: 541-783-2292
  • Fax: 541-783-3160
Mailing address:
  • Phone: 541-851-8110
  • Fax: 541-851-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SIGNE PORTER
Title or Position: CEO
Credential:
Phone: 541-880-2022