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General NPI Number Information
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NPI Number | 1447256250
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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 | 06/27/2005
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 601 MEDICAL PARKWAY
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City | ENTERPRISE
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State | OR
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Zip | 97828-1167
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Country | US
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Telephone | 541-426-3111
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Fax | 541-426-1901
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Provider Business Mailing Address
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Address Line | 601 MEDICAL PARKWAY
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City | ENTERPRISE
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State | OR
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Zip | 97828
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Country | US
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Telephone | 541-426-3111
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Fax | 541-426-1901
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | JOSEPH MATTHEW 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 140068
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QC0050X
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Taxonomy Name | Critical Access Hospital Clinic/Center
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License Number | 14-0068
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License Number State | OR
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