Healthcare Provider Details

I. General information

NPI: 1154565190
Provider Name (Legal Business Name): UMATILLA-MORROW ESD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SW NYE AVE
PENDLETON OR
97801-4416
US

IV. Provider business mailing address

2001 SW NYE AVE
PENDLETON OR
97801-4416
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-3100
  • Fax: 541-276-4245
Mailing address:
  • Phone: 541-966-3100
  • Fax: 541-276-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK MULVIHILL
Title or Position: SUPERINTENDENT
Credential:
Phone: 541-966-3102