Provider Demographics
NPI:1881763852
Name:MID COLUMBIA HEALTH SERVICES
Entity type:Organization
Organization Name:MID COLUMBIA HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-296-1111
Mailing Address - Street 1:PO BOX 4800
Mailing Address - Street 2:UNIT 17
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4800
Mailing Address - Country:US
Mailing Address - Phone:888-633-0087
Mailing Address - Fax:
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-296-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8922672OtherWA CRIME VICTIMS
WA7058977Medicaid
35236OtherWORKERS COMP
0235001OtherPREFERRED ONE
OR168114Medicaid
0235001OtherPREFERRED ONE
OR168114Medicaid