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General NPI Number Information
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NPI Number | 1205804101
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Entity Type | Organization
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Legal Business Name | MID-COLUMBIA MEDICAL CENTER
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1935 E 19TH ST STE 110
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City | THE DALLES
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State | OR
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Zip | 97058-3392
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1580
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City | THE DALLES
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State | OR
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Zip | 97058-8004
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Country | US
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Telephone | 541-296-7280
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Fax | 541-296-7631
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Authorized Official
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Title or Position | SERVICE AREA PRESIDENT
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Name | KYLE KING
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Credential |
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Telephone | 503-261-4405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 13 140500
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License Number State | OR
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