Healthcare Provider Details

I. General information

NPI: 1730956178
Provider Name (Legal Business Name): MALHEUR COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 SW 4TH ST
ONTARIO OR
97914-4305
US

IV. Provider business mailing address

1108 SW 4TH ST
ONTARIO OR
97914-4305
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-7279
  • Fax: 541-889-8468
Mailing address:
  • Phone: 541-889-7279
  • Fax: 541-889-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEAH WISHARD
Title or Position: BILLER
Credential:
Phone: 541-889-7279