MEDICARE: KLAMATH COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	043054	OR
2	251K00000X	Public Health or Welfare Agency	320051	OR
3	251K00000X	Public Health or Welfare Agency	000075	OR
4	261QA0005X	Ambulatory Family Planning Facility
5	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780607739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLAMATH COUNTY

Provider Business Mailing Address
First Line	:	3314 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3730
Country	:	US
Telephone Number	:	541-882-8846
Fax Number	:	541-885-3638

Provider Business Practice Location Address
First Line	:	3314 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3730
Country	:	US
Telephone Number	:	541-882-8846
Fax Number	:	541-885-3638

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR
Name	:	JESSICA FAITH DALE
Credential	:
Telephone Number	:	541-885-2434

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	09/17/2024

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Directions to “KLAMATH COUNTY ” Practice Location

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