Healthcare Provider Details

I. General information

NPI: 1932161361
Provider Name (Legal Business Name): BENTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NW 27TH ST
CORVALLIS OR
97330-5223
US

IV. Provider business mailing address

PO BOX 579
CORVALLIS OR
97339-0579
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-6835
  • Fax: 541-766-6164
Mailing address:
  • Phone: 541-766-6835
  • Fax: 541-766-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number227701
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LACEY MOLLEL
Title or Position: HEALTH CENTER DIRECTOR
Credential:
Phone: 541-766-6835