Healthcare Provider Details

I. General information

NPI: 1366972499
Provider Name (Legal Business Name): PHILIP M RUUD BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SW 30TH ST
PENDLETON OR
97801-3912
US

IV. Provider business mailing address

815 SW 30TH ST
PENDLETON OR
97801-3912
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-0427
  • Fax: 541-320-7176
Mailing address:
  • Phone: 541-429-0427
  • Fax: 541-320-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00000290
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-P-924167
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: