Organization
UMPQUA COMMUNITY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KC BOLTON (CEO)
(541) 672-9596
Entity
Organization
Contact information
Practice address
790 S. MAIN, MYRTLE CREEK, OR 97457
(541) 860-4070
(541) 860-5032
Mailing address
150 KENNETH FORD DRIVE, ROSEBURG, OR 97470-1042
(541) 672-9596
(541) 464-3519
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168395
—
OR
Enumeration date
10/16/2008
Last updated
06/28/2022
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