Healthcare Provider Details

I. General information

NPI: 1255149175
Provider Name (Legal Business Name): HERMISTON MEDICAL CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E15
HERMISTON OR
97838-8602
US

IV. Provider business mailing address

600 NW 11TH ST STE E15
HERMISTON OR
97838-8602
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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