Provider Demographics
NPI:1689023780
Name:KLAMATH HEALTH PARTNERSHIP INC
Entity Type:Organization
Organization Name:KLAMATH HEALTH PARTNERSHIP INC
Other - Org Name:KLAMATH OPEN DOOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DO/CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-851-8110
Mailing Address - Street 1:2074 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-3372
Mailing Address - Country:US
Mailing Address - Phone:541-851-8110
Mailing Address - Fax:541-851-0190
Practice Address - Street 1:2074 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-3372
Practice Address - Country:US
Practice Address - Phone:541-851-8110
Practice Address - Fax:541-851-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336I0012X
ORRP00031983336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500719898Medicaid
OR170061Medicaid
OR381963Medicare Oscar/Certification
OR381897Medicare Oscar/Certification
OR381845Medicare Oscar/Certification