Basic Information
Provider Information | |||||||||
NPI: | 1649330986 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SILVERTON HOSPITAL OCCUPATIONAL HEALTH | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1475 MOUNT HOOD AVE | ||||||||
Address2: |   | ||||||||
City: | WOODBURN | ||||||||
State: | OR | ||||||||
PostalCode: | 970719066 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9719835361 | ||||||||
FaxNumber: | 9719835343 | ||||||||
Practice Location | |||||||||
Address1: | 1475 MOUNT HOOD AVE | ||||||||
Address2: |   | ||||||||
City: | WOODBURN | ||||||||
State: | OR | ||||||||
PostalCode: | 970719066 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9719835361 | ||||||||
FaxNumber: | 9719835343 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/09/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BOWES | ||||||||
AuthorizedOfficialFirstName: | YUTONAH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9719835362 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.