Healthcare Provider Details

I. General information

NPI: 1194010116
Provider Name (Legal Business Name): ST.ANTHONY HOSPITAL WE CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SE COURT AVE
PENDLETON OR
97801-3217
US

IV. Provider business mailing address

1601 SE COURT
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-0508
  • Fax:
Mailing address:
  • Phone: 541-278-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number201150057
License Number StateOR

VIII. Authorized Official

Name: JUSTIN PEARCE
Title or Position: DIRECTOR OF MEDICAL SERVICES
Credential: JD
Phone: 541-966-0508