Provider Demographics
NPI:1639316193
Name:LA PINE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:LA PINE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-876-1837
Mailing Address - Street 1:PO BOX 3300
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-3300
Mailing Address - Country:US
Mailing Address - Phone:541-536-3435
Mailing Address - Fax:541-536-8047
Practice Address - Street 1:51600 HUNTINGTON ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-0001
Practice Address - Country:US
Practice Address - Phone:541-536-3435
Practice Address - Fax:541-536-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500609414Medicaid
OR381915Medicare Oscar/Certification