Provider Demographics
NPI:1356971493
Name:OREGON WASHINGTON HEALTH NETWORK
Entity type:Organization
Organization Name:OREGON WASHINGTON HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-429-8049
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0882
Mailing Address - Country:US
Mailing Address - Phone:541-429-8844
Mailing Address - Fax:
Practice Address - Street 1:715 SW DORION AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2070
Practice Address - Country:US
Practice Address - Phone:541-429-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON WASHINGTON HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-16
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR50077491Medicaid