Provider Demographics
NPI:1881630713
Name:COUNTY OF UMATILLA
Entity type:Organization
Organization Name:COUNTY OF UMATILLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-278-5432
Mailing Address - Street 1:200 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2503
Mailing Address - Country:US
Mailing Address - Phone:541-278-5432
Mailing Address - Fax:541-278-5433
Practice Address - Street 1:200 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2503
Practice Address - Country:US
Practice Address - Phone:541-278-5432
Practice Address - Fax:541-278-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251B00000X, 251K00000X
261QA0005X, 261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR042999Medicaid
OR097154Medicaid
OR320226Medicaid
OR320226Medicaid