Basic Information
| Provider Information | |||||||||
| NPI: | 1780880518 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST ANTHONY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST ANTHONY HOSPITAL FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 ST ANTHONY WAY | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412765121 | ||||||||
| FaxNumber: | 5412786564 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 ST ANTHONY WAY | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412788183 | ||||||||
| FaxNumber: | 5412786564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GELLER | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5412783222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 140034 | OR | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.