Healthcare Provider Details

I. General information

NPI: 1942718457
Provider Name (Legal Business Name): MID-COLUMBIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 LONE PINE BLVD STE 200B
THE DALLES OR
97058-9404
US

IV. Provider business mailing address

PO BOX 1520
THE DALLES OR
97058-8003
US

V. Phone/Fax

Practice location:
  • Phone: 541-298-5563
  • Fax: 541-298-7746
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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