Healthcare Provider Details

I. General information

NPI: 1851369409
Provider Name (Legal Business Name): MID-COLUMBIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 19TH ST
THE DALLES OR
97058-3317
US

IV. Provider business mailing address

1700 E 19TH ST
THE DALLES OR
97058-3317
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-7760
  • Fax: 541-296-7619
Mailing address:
  • Phone: 541-296-7760
  • Fax: 541-296-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number14 0500
License Number StateOR

VIII. Authorized Official

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