MEDICARE: KLAMATH HEALTH PARTNERSHIP, INC

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	261QS1000X	Student Health Clinic/Center

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

General Provider Information

NPI Number	:	1962966184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLAMATH HEALTH PARTNERSHIP, INC

Provider Business Mailing Address
First Line	:	2074 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-3372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3013 SUMMERS LANE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-9760
Country	:	US
Telephone Number	:	541-851-8110
Fax Number	:

Authorized Official
Title or Position	:	CPES
Name	:	JEANA MASTERS
Credential	:
Telephone Number	:	541-880-2011

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	08/06/2020

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