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General NPI Number Information
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NPI Number | 1871833772
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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 | 03/01/2013
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1810 E 19TH ST STE 209
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City | THE DALLES
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State | OR
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Zip | 97058-3388
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Country | US
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Telephone | 541-296-5657
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Fax | 541-298-5199
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Provider Business Mailing Address
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Address Line | PO BOX 1520 1810 E. 19TH ST. STE.209
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City | THE DALLES
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State | OR
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Zip | 97058-3388
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Country | US
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Telephone | 541-296-5657
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Fax | 541-298-5199
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 383895
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License Number State | OR
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