Provider Demographics
NPI:1659470441
Name:THE WOMEN'S CENTER OF CENTRAL OREGON
Entity Type:Organization
Organization Name:THE WOMEN'S CENTER OF CENTRAL OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-923-5886
Mailing Address - Street 1:1001 NW CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1420
Mailing Address - Country:US
Mailing Address - Phone:541-504-7635
Mailing Address - Fax:541-923-5902
Practice Address - Street 1:1001 NW CANAL BLVD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1420
Practice Address - Country:US
Practice Address - Phone:541-504-7635
Practice Address - Fax:541-923-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22835261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288033OtherOMAP PROVIDER #
ORR130898Medicare ID - Type Unspecified
ORG57297Medicare UPIN