Healthcare Provider Details

I. General information

NPI: 1528442837
Provider Name (Legal Business Name): WALLOWA COUNTY HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

IV. Provider business mailing address

601 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-7900
  • Fax:
Mailing address:
  • Phone: 541-426-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number140068
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSEPH MATTHEW WANNER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 541-426-5460