Organization
MID-COLUMBIA MEDICAL CENTER
Active
Other names
MCMC FAMILY MEDICINE, Adventist Health Columbia Gorge
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE KING (SERVICE AREA PRESIDENT)
(503) 261-4405
Entity
Organization
Contact information
Practice address
1620 E 12TH ST, THE DALLES, OR 97058
(541) 296-9151
(541) 296-9156
Mailing address
1620 E 12TH ST, PO BOX 1520, THE DALLES, OR 97058
(541) 296-9151
(541) 296-9156
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
OR
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003624
—
WA
05
—
218112
—
OR
Enumeration date
07/04/2006
Last updated
04/14/2025
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