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General NPI Number Information
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NPI Number | 1982764882
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Entity Type | Organization
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Legal Business Name | BENTON COUNTY
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 121 SE VIEWMONT AVE
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City | CORVALLIS
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State | OR
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Zip | 97333-1968
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Country | US
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Telephone | 541-766-3546
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Fax | 541-766-6143
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Provider Business Mailing Address
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Address Line | PO BOX 579
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City | CORVALLIS
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State | OR
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Zip | 97339-0579
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Country | US
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Telephone | 541-766-3546
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Fax | 541-766-6143
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Authorized Official
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Title or Position | HEALTH CENTER DIRECTOR
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Name | LACEY MOLLEL
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Credential |
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Telephone | 541-766-6835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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