Healthcare Provider Details

I. General information

NPI: 1437355955
Provider Name (Legal Business Name): PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 HIGHWAY 35
MT HOOD OR
97041
US

IV. Provider business mailing address

PO BOX 3390
PORTLAND OR
97208-3390
US

V. Phone/Fax

Practice location:
  • Phone: 503-337-2292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONALD GUTH
Title or Position: CHIEF FINCANCE OFFICER
Credential:
Phone: 541-387-6451