Provider Demographics
NPI:1790167831
Name:WALLOWA COUNTY HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:WALLOWA COUNTY HEALTH CARE DISTRICT
Other - Org Name:WALLOWA MEMORIAL MEDICAL CLINIC - JOSEPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-426-5460
Mailing Address - Street 1:601 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-5124
Mailing Address - Country:US
Mailing Address - Phone:541-426-7900
Mailing Address - Fax:
Practice Address - Street 1:800 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:JOSEPH
Practice Address - State:OR
Practice Address - Zip Code:97846-8451
Practice Address - Country:US
Practice Address - Phone:541-432-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALLOWA COUNTY HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-25
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QR1300X
OR140068282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access