Healthcare Provider Details

I. General information

NPI: 1982607016
Provider Name (Legal Business Name): CITY OF PENDLETON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 SE COURT AVE
PENDLETON OR
97801-3212
US

IV. Provider business mailing address

911 SW COURT AVE
PENDLETON OR
97801-1912
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-1442
  • Fax:
Mailing address:
  • Phone: 541-276-1442
  • Fax: 541-276-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3005-05
License Number StateOR

VIII. Authorized Official

Name: KAREN HOEFT
Title or Position: SR ACCOUNT CLERK
Credential:
Phone: 541-276-1442