Provider Demographics
NPI:1285018754
Name:OROFINO HEALTH CENTER
Entity Type:Organization
Organization Name:OROFINO HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-476-8000
Mailing Address - Street 1:1055 RIVERSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544
Mailing Address - Country:US
Mailing Address - Phone:208-476-5777
Mailing Address - Fax:208-476-5385
Practice Address - Street 1:301 CEDAR ST
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9029
Practice Address - Country:US
Practice Address - Phone:208-476-4555
Practice Address - Fax:208-476-5385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARWATER VALLEY HOSPITAL & CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty