Provider Demographics
NPI:1093834004
Name:UMATILLA MEDICAL CLINIC
Entity Type:Organization
Organization Name:UMATILLA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:MEHARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-922-3104
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:1890 E 7TH STREET
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-0790
Mailing Address - Country:US
Mailing Address - Phone:541-922-3104
Mailing Address - Fax:541-922-2951
Practice Address - Street 1:1890 E 7TH STREET
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-0790
Practice Address - Country:US
Practice Address - Phone:541-922-3104
Practice Address - Fax:541-922-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR058545Medicaid
ORC19263Medicare UPIN
ORR 0000 BLBRZMedicare ID - Type UnspecifiedMEDICARE NUMBER