Healthcare Provider Details

I. General information

NPI: 1992094817
Provider Name (Legal Business Name): MID-COLUMBIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E 19TH ST
THE DALLES OR
97058-3365
US

IV. Provider business mailing address

PO BOX 1520
THE DALLES OR
97058-8003
US

V. Phone/Fax

Practice location:
  • Phone: 541-506-6920
  • Fax: 541-296-5451
Mailing address:
  • Phone: 541-506-6920
  • Fax: 541-296-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS KNOX
Title or Position: CORPORATE OFFICER CEO
Credential:
Phone: 541-296-7273