Healthcare Provider Details

I. General information

NPI: 1871833772
Provider Name (Legal Business Name): MID-COLUMBIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 E 19TH ST STE 209
THE DALLES OR
97058-3388
US

IV. Provider business mailing address

PO BOX 1520 1810 E. 19TH ST. STE.209
THE DALLES OR
97058-3388
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-5657
  • Fax: 541-298-5199
Mailing address:
  • Phone: 541-296-5657
  • Fax: 541-298-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number383895
License Number StateOR

VIII. Authorized Official

Name: KYLE KING
Title or Position: SERVICE AREA PRESIDENT
Credential:
Phone: 503-261-4405