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General NPI Number Information
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NPI Number | 1700502440
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Entity Type | Organization
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Legal Business Name | UMPQUA COMMUNITY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 1423 NW FAIRMOUNT ST
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City | ROSEBURG
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State | OR
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Zip | 97470-2065
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Country | US
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Telephone | 541-672-9596
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Fax | 541-492-2060
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Provider Business Mailing Address
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Address Line | 150 NE KENNETH FORD DR
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City | ROSEBURG
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State | OR
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Zip | 97470-1042
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Country | US
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Telephone | 541-672-9596
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Fax | 541-492-2060
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Authorized Official
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Title or Position | CEO
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Name | KC BOLTON
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Credential |
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Telephone | 541-672-9596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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