Healthcare Provider Details

I. General information

NPI: 1275852337
Provider Name (Legal Business Name): SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 9TH ST
ONTARIO OR
97914-2639
US

IV. Provider business mailing address

351 SW 9TH ST
ONTARIO OR
97914-2639
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7000
  • Fax: 541-881-7186
Mailing address:
  • Phone: 541-881-7000
  • Fax: 541-881-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LANNIE CHECKETTS
Title or Position: CFO
Credential:
Phone: 208-367-7347