Provider Demographics
NPI:1720417710
Name:ST. CHARLES HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:ST. CHARLES HEALTH SYSTEM, INC.
Other - Org Name:ST. CHARLES RADIOLOGY SISTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP / CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-706-7707
Mailing Address - Street 1:PO BOX 5579
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-5579
Mailing Address - Country:US
Mailing Address - Phone:541-549-1318
Mailing Address - Fax:541-588-6002
Practice Address - Street 1:630 N ARROWLEAF TRL
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2610
Practice Address - Country:US
Practice Address - Phone:541-549-1318
Practice Address - Fax:541-588-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology