Provider Demographics
NPI:1164418745
Name:GRANT COUNTY HEALTH DEPARTMANE
Entity Type:Organization
Organization Name:GRANT COUNTY HEALTH DEPARTMANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-575-0429
Mailing Address - Street 1:528 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-1240
Mailing Address - Country:US
Mailing Address - Phone:541-575-0429
Mailing Address - Fax:541-575-3604
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1240
Practice Address - Country:US
Practice Address - Phone:541-575-0429
Practice Address - Fax:541-575-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100439Medicaid
OR100439Medicaid
ORMT007267OtherDEA #
OR100439Medicaid