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General NPI Number Information
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NPI Number | 1184170748
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Entity Type | Organization
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Legal Business Name | WALLOWA COUNTY HEALTH CARE DISTRICT
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 16351 E. 104TH PLACE
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City | COMMERCE CITY
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State | CO
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Zip | 80022
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Country | US
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Telephone | 609-605-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 16351 E 104TH PL
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City | COMMERCE CITY
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State | CO
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Zip | 80022-8843
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Country | US
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Telephone | 609-605-9200
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JOSEPH WANNER
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Credential |
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Telephone | 541-426-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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