Provider Demographics
NPI:1578565347
Name:CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT
Entity Type:Organization
Organization Name:CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-304-7659
Mailing Address - Street 1:3750 CHEMAWA RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1119
Mailing Address - Country:US
Mailing Address - Phone:503-304-7600
Mailing Address - Fax:503-304-7678
Practice Address - Street 1:3750 CHEMAWA RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1119
Practice Address - Country:US
Practice Address - Phone:503-304-7600
Practice Address - Fax:503-304-7678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278159Medicaid
OR278159Medicaid