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Organization
GRANDE RONDE HOSPITAL
Active
Organization
GRANDE RONDE HOSPITAL
Active
Other names
Grande Ronde Hospital Childrens Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES MATTES (PRESIDENT)
(541) 963-1469
Entity
Organization
Contact information
Practice address
612 SUNSET DR, LA GRANDE, OR 97850-1248
(541) 963-9123
(541) 962-0695
Mailing address
612 SUNSET DR, LA GRANDE, OR 97850-1248
(541) 963-9123
(541) 962-0695
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
394792
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067801
—
OR
Enumeration date
06/12/2006
Last updated
11/09/2007
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