Provider Demographics
NPI:1497797856
Name:HEALTHCARE FOR THE MID-COLUMBIA REGION
Entity Type:Organization
Organization Name:HEALTHCARE FOR THE MID-COLUMBIA REGION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-296-1111
Mailing Address - Street 1:PO BOX 4800
Mailing Address - Street 2:UNIT 17
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-296-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8906928OtherWASHINGTON CRIME VICTIMS
WA7128747Medicaid
DD6600OtherRAILROAD MEDICARE
200123OtherUS DEPTARTMENT OF LABOR
OR276307Medicaid
865374000OtherBLUE CROSS/BLUE SHIELD
8906928OtherWASHINGTON CRIME VICTIMS