Provider Demographics
NPI:1679943096
Name:MID-COLUMBIA COUNCIL OF GOVERNMENTS
Entity Type:Organization
Organization Name:MID-COLUMBIA COUNCIL OF GOVERNMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPORTATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-288-9302
Mailing Address - Street 1:1113 KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2767
Mailing Address - Country:US
Mailing Address - Phone:541-288-9302
Mailing Address - Fax:855-835-5274
Practice Address - Street 1:1113 KELLY AVE
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2767
Practice Address - Country:US
Practice Address - Phone:541-288-9302
Practice Address - Fax:855-835-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230767Medicaid