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General NPI Number Information
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NPI Number | 1255149175
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Entity Type | Organization
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Legal Business Name | HERMISTON MEDICAL CENTER P C
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 600 NW 11TH ST STE E15
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City | HERMISTON
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State | OR
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Zip | 97838-8602
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Country | US
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Telephone | 541-567-6434
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Fax |
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Provider Business Mailing Address
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Address Line | 600 NW 11TH ST STE E15
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City | HERMISTON
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State | OR
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Zip | 97838-8602
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Country | US
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Telephone | 541-567-6434
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DEREK TED EARL
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Credential | MD
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Telephone | 541-567-6434
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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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