Provider Demographics
NPI:1083633184
Name:MOSAIC COMMUNITY HEALTH
Entity Type:Organization
Organization Name:MOSAIC COMMUNITY HEALTH
Other - Org Name:OCHOCO HEALTH SYSTEMS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-788-6470
Mailing Address - Street 1:600 SW COLUMBIA ST
Mailing Address - Street 2:SUITE 6210
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1099
Mailing Address - Country:US
Mailing Address - Phone:541-323-3181
Mailing Address - Fax:541-706-9895
Practice Address - Street 1:375 NW BEAVER STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-447-0707
Practice Address - Fax:541-447-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182960Medicaid
ORR113987Medicare Oscar/Certification
OR381942Medicare Oscar/Certification
OR381940Medicare Oscar/Certification
OR381958Medicare Oscar/Certification
OR381848Medicare Oscar/Certification
OR182960Medicaid
OR381860Medicare Oscar/Certification
OR381941Medicare Oscar/Certification
OR381948Medicare Oscar/Certification
ORS29006Medicare UPIN
Q74717Medicare UPIN
G85625Medicare UPIN
ORG84019Medicare UPIN
ORG59055Medicare UPIN
OR113987Medicare ID - Type Unspecified
ORS12474Medicare UPIN
ORS89153Medicare UPIN