Provider Demographics
NPI:1083895767
Name:GRANDE RONDE HOSPITAL INC
Entity Type:Organization
Organization Name:GRANDE RONDE HOSPITAL INC
Other - Org Name:GRANDE RONDE HOSPITAL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-963-1469
Mailing Address - Street 1:700 SUNSET DR STE G
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1260
Mailing Address - Country:US
Mailing Address - Phone:541-963-6070
Mailing Address - Fax:541-963-6490
Practice Address - Street 1:700 SUNSET DR STE G
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1260
Practice Address - Country:US
Practice Address - Phone:541-963-6070
Practice Address - Fax:541-963-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR394792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty