Provider Demographics
NPI:1790865855
Name:COLUMBIA GORGE MIDWIFERY
Entity type:Organization
Organization Name:COLUMBIA GORGE MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPM,LDM
Authorized Official - Phone:541-490-3140
Mailing Address - Street 1:2324 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-8671
Mailing Address - Country:US
Mailing Address - Phone:541-490-3140
Mailing Address - Fax:541-386-8365
Practice Address - Street 1:2324 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-8671
Practice Address - Country:US
Practice Address - Phone:541-490-3140
Practice Address - Fax:541-386-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10113722176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty