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General NPI Number Information
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NPI Number | 1992094817
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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 | 03/31/2011
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 1825 E 19TH ST
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City | THE DALLES
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State | OR
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Zip | 97058-3365
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Country | US
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Telephone | 541-506-6920
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Fax | 541-296-5451
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Provider Business Mailing Address
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Address Line | PO BOX 1520
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City | THE DALLES
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State | OR
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Zip | 97058-8003
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Country | US
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Telephone | 541-506-6920
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Fax | 541-296-5451
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Authorized Official
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Title or Position | CORPORATE OFFICER CEO
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Name | DENNIS KNOX
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Credential |
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Telephone | 541-296-7273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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