Healthcare Provider Details

I. General information

NPI: 1659470441
Provider Name (Legal Business Name): THE WOMEN'S CENTER OF CENTRAL OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NW CANAL BLVD
REDMOND OR
97756-1420
US

IV. Provider business mailing address

1001 NW CANAL BLVD
REDMOND OR
97756-1420
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-7635
  • Fax: 541-923-5902
Mailing address:
  • Phone: 541-504-7635
  • Fax: 541-923-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD22835
License Number StateOR

VIII. Authorized Official

Name: DONNA M FISHER
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 541-923-5886