Provider Demographics
NPI:1093877185
Name:WALLOWA COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:WALLOWA COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-426-4848
Mailing Address - Street 1:758 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1527
Mailing Address - Country:US
Mailing Address - Phone:541-426-4848
Mailing Address - Fax:541-426-3627
Practice Address - Street 1:758 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1527
Practice Address - Country:US
Practice Address - Phone:541-426-4848
Practice Address - Fax:541-426-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000851Medicaid
OR114299Medicare ID - Type UnspecifiedMEDICARE ID #