Organization
SAMARITAN HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN DOUGLAS WYMORE RD, LD (REGISTERED DIETITIAN)
(541) 232-9615
Entity
Organization
Contact information
Practice address
620 ELM ST SW # 2, ALBANY, OR 97321-1986
(541) 812-4839
Mailing address
117 SW 4TH ST APT 2, CORVALLIS, OR 97333-4717
(541) 232-9615
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
282N00000X
General Acute Care Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86065504
COMMISION ON DIETETIC REGISTRATION
—
01
—
LDD10175002
OREGON DIETETIC LICENSURE
OR
Enumeration date
11/08/2016
Last updated
11/08/2016
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