Healthcare Provider Details

I. General information

NPI: 1467403329
Provider Name (Legal Business Name): HERMISTON MEDICAL CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST SUITE E 15
HERMISTON OR
97838
US

IV. Provider business mailing address

600 NW 11TH STREET SUITE E 15
HERMISTON OR
97838
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-6434
  • Fax: 541-567-6019
Mailing address:
  • Phone: 541-567-6434
  • Fax: 541-567-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD08491
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD11635
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO23298
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD14374
License Number StateOR

VIII. Authorized Official

Name: DEREK TED EARL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 541-567-6434