Healthcare Provider Details

I. General information

NPI: 1619900370
Provider Name (Legal Business Name): LOWER UMPQUA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 RANCH RD
REEDSPORT OR
97467
US

IV. Provider business mailing address

600 RANCH RD
REEDSPORT OR
97467-1720
US

V. Phone/Fax

Practice location:
  • Phone: 541-271-2163
  • Fax: 541-271-4058
Mailing address:
  • Phone: 541-271-2171
  • Fax: 541-271-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHNATHON CHIVERS
Title or Position: CEO
Credential:
Phone: 541-271-6313