Organization
MID-COLUMBIA MEDICAL CENTER
Active
Other names
MCMC Surgical Clinic, 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
1810 E. 19TH ST. #225, THE DALLES, OR 97058
(541) 296-6101
(541) 296-0025
Mailing address
PO BOX 1520, THE DALLES, OR 97058
(541) 298-7971
(541) 296-6431
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
208600000X
Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2057713
—
WA
05
—
500704145
—
OR
Enumeration date
01/26/2016
Last updated
04/14/2025
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