Provider Demographics
NPI:1255149175
Name:HERMISTON MEDICAL CENTER P C
Entity type:Organization
Organization Name:HERMISTON MEDICAL CENTER P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:TED
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-567-6434
Mailing Address - Street 1:600 NW 11TH ST STE E15
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8602
Mailing Address - Country:US
Mailing Address - Phone:541-567-6434
Mailing Address - Fax:
Practice Address - Street 1:600 NW 11TH ST STE E15
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8602
Practice Address - Country:US
Practice Address - Phone:541-567-6434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health