Provider Demographics
NPI:1437355955
Name:PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Other - Org Name:PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL MT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINCANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-387-6451
Mailing Address - Street 1:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14040 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MT HOOD
Practice Address - State:OR
Practice Address - Zip Code:97041
Practice Address - Country:US
Practice Address - Phone:503-337-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR119126Medicare PIN