Organization
MID-COLUMBIA MEDICAL CENTER
Active
Other names
Adventist Health Columbia Gorge, Water's Edge Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE KING (SERVICE AREA PRESIDENT)
(503) 261-4405
Entity
Organization
Contact information
Practice address
551 LONE PINE BLVD, THE DALLES, OR 97058
(541) 506-6920
(541) 296-5451
Mailing address
551 LONE PINE BLVD, PO BOX 1520, THE DALLES, OR 97058
(541) 506-6920
(541) 296-5451
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009681
—
WA
05
—
218103
—
OR
05
—
276258
—
OR
Enumeration date
07/05/2006
Last updated
04/14/2025
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