Organization
GRANDE RONDE HOSPITAL
Active
Other names
Grande Ronde Hospital Childrens Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES MATTES (PRESIDENT)
(541) 963-1469
Entity
Organization
Contact information
Practice address
612 SUNSET DR, LA GRANDE, OR 97850-1248
(541) 963-9123
(541) 962-0695
Mailing address
612 SUNSET DR, LA GRANDE, OR 97850-1248
(541) 963-9123
(541) 962-0695
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
394792
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067801
—
OR
Enumeration date
06/12/2006
Last updated
11/09/2007
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