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COLUMBIA GORGE MEDICAL CENTER PC NPI 1558346064


NPI Information

NPI: 1558346064
Provider Name: COLUMBIA GORGE MEDICAL CENTER PC

Doing Business As: COLUMBIA GORGE FAMILY MEDICINE

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 38D0622013

Address:
1750 12TH ST
HOOD RIVER, OR
ZIP 97031
Phone: (541) 386-5070
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COLUMBIA GORGE MEDICAL CENTER PC is a clinic center in Hood River, OR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). COLUMBIA GORGE MEDICAL CENTER PC NPI is 1558346064. The provider is registered as an organization entity type.
The provider Is Doing Business As Columbia Gorge Family Medicine.

The provider's business location address is:

1750 12TH ST
HOOD RIVER, OR
ZIP 97031-513
Phone: (541) 386-5070
Fax: (541) 386-7190

The provider's authorized official is Tyler Gray .
The authorized official title is Managing Partner and has the following contact phone number (541) 386-5070.

The CLIA number assigned to this NPI record is 38D0622013 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/7/2005 and was last updated on 2/16/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R0000WCJPVMEDICARE UPIN
2198383OTHERUNITED HEALTHCARE
38901302OTHERWASHINGTONDEPT OF LABOR AND INDUSTR
4176180MEDICAIDOREGON
57002678MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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