Healthcare Provider Details

I. General information

NPI: 1437453776
Provider Name (Legal Business Name): ST. CHARLES HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 NW JACKPINE AVENUE
REDMOND OR
97756-1334
US

IV. Provider business mailing address

PO BOX 1420
REDMOND OR
97756-0400
US

V. Phone/Fax

Practice location:
  • Phone: 541-526-6661
  • Fax: 541-548-3764
Mailing address:
  • Phone: 541-526-6556
  • Fax: 541-706-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN M SHEPARD
Title or Position: SR VP FINANCE / CFO
Credential:
Phone: 541-706-7707