Healthcare Provider Details

I. General information

NPI: 1558366229
Provider Name (Legal Business Name): WALLOWA COUNTY HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MEDICAL PARKWAY
ENTERPRISE OR
97828-1167
US

IV. Provider business mailing address

601 MEDICAL PARKWAY
ENTERPRISE OR
97828-5124
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-3111
  • Fax: 541-426-1901
Mailing address:
  • Phone: 541-426-3111
  • Fax: 541-426-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number14 0068
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

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