Provider Demographics
NPI:1982607016
Name:CITY OF PENDLETON
Entity Type:Organization
Organization Name:CITY OF PENDLETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR ACCOUNT CLERK
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-276-1442
Mailing Address - Street 1:911 SW COURT AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1912
Mailing Address - Country:US
Mailing Address - Phone:541-276-1442
Mailing Address - Fax:541-276-9171
Practice Address - Street 1:1455 SE COURT AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3212
Practice Address - Country:US
Practice Address - Phone:541-276-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3005-053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR149393Medicaid
OR9571407OtherWASHINGTON MEDICAID
OR8060348000Medicaid
OR085387000OtherBLUE CROSS
OR28045OtherWASHINGTON LABOR AND INDU
OR590133278OtherRAILROAD MEDICARE
OR085387000OtherBLUE CROSS