Healthcare Provider Details

I. General information

NPI: 1407178528
Provider Name (Legal Business Name): ST. CHARLES HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 SE COMBS FLAT RD SUITE 1200
PRINEVILLE OR
97754-2562
US

IV. Provider business mailing address

PO BOX 6095
BEND OR
97708-6095
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-6263
  • Fax: 541-447-8724
Mailing address:
  • Phone: 541-382-4321
  • Fax: 541-447-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SWAFFORD
Title or Position: CFO
Credential:
Phone: 541-382-4321