Organization
GRANDE RONDE HOSPITAL, INC.
Active
Other names
GRANDE RONDE HOSPITAL INTERNAL MEDICINE CLINIC, GRANDE RONDE HOSPITAL REGIONAL MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY P DAVIS (PRESIDENT/CEO)
(541) 963-8421
Entity
Organization
Contact information
Practice address
506 4TH ST, LA GRANDE, OR 97850-1906
(541) 963-3138
(541) 963-5918
Mailing address
PO BOX 460, LA GRANDE, OR 97850-0460
(541) 963-3138
(541) 963-5918
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276310
—
OR
01
—
DE0048
RR MEDICARE
OR
Enumeration date
07/04/2006
Last updated
07/26/2021
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