Organization
CITY OF PENDLETON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN HOEFT (SR ACCOUNT CLERK)
(541) 276-1442
Entity
Organization
Contact information
Practice address
1455 SE COURT AVE, PENDLETON, OR 97801-3212
(541) 276-1442
Mailing address
911 SW COURT AVE, PENDLETON, OR 97801-1912
(541) 276-1442
(541) 276-9171
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
3005-05
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085387000
BLUE CROSS
OR
05
—
149393
—
OR
01
—
28045
WASHINGTON LABOR AND INDU
OR
01
—
590133278
RAILROAD MEDICARE
OR
05
—
8060348000
—
OR
01
—
9571407
WASHINGTON MEDICAID
OR
Enumeration date
05/23/2005
Last updated
08/03/2021
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