Basic Information
Provider Information | |||||||||
NPI: | 1083656367 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CURRY HEALTH DISTRICT | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CURRY MEDICAL CENTER (FORMERLY BROOKINGS MEDICAL CENTER) | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 94220 4TH ST | ||||||||
Address2: |   | ||||||||
City: | GOLD BEACH | ||||||||
State: | OR | ||||||||
PostalCode: | 974447756 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5412473000 | ||||||||
FaxNumber: | 5412473154 | ||||||||
Practice Location | |||||||||
Address1: | 500 5TH STREET | ||||||||
Address2: |   | ||||||||
City: | BROOKINGS | ||||||||
State: | OR | ||||||||
PostalCode: | 974159702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5414122000 | ||||||||
FaxNumber: | 5414122081 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2006 | ||||||||
LastUpdateDate: | 03/26/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RAZO | ||||||||
AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
AuthorizedOfficialMiddleName: | A. | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 5412473108 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | CURRY HEALTH DISTRICT | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 261QM1300X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QC0050X | 14-0251 | OR | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
ID Information
ID | Type | State | Issuer | Description | 119263 | 05 | OR |   | MEDICAID |