# MID-COLUMBIA MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MCMC Surgical Clinic, Adventist Health Columbia Gorge
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366809048
- **Authorized official:** KYLE KING (SERVICE AREA PRESIDENT)
- **Authorized official phone:** (503) 261-4405

## Contact information

- **Practice address:** 1810 E. 19TH ST. \#225, THE DALLES, OR 97058
- **Practice address phone:** (541) 296-6101
- **Practice address fax:** (541) 296-0025
- **Mailing address:** PO BOX 1520, THE DALLES, OR 97058
- **Mailing address phone:** (541) 298-7971
- **Mailing address fax:** (541) 296-6431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207T00000X | Neurological Surgery Physician | — | NULL | — |
| 207T00000X | Neurological Surgery Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/26/2016
- **Last updated:** 04/14/2025