Basic Information
| Provider Information | |||||||||
| NPI: | 1821364944 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBIA GORGE MEDICAL CENTER PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLUMBIA GORGE FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1750 12TH ST | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970319540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413865070 | ||||||||
| FaxNumber: | 5413867190 | ||||||||
| Practice Location | |||||||||
| Address1: | 1750 12TH ST | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970319540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413865070 | ||||||||
| FaxNumber: | 5413867190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2012 | ||||||||
| LastUpdateDate: | 03/23/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DILLON | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
| AuthorizedOfficialMiddleName: | GAIL | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5413865070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.