NPIMap

Organization Active NPI

Winding Waters Medical Clinic

  • Community/Retail Pharmacy
  • Wallowa, OR
National Provider Identifier
1114631322
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
WINDING WATERS MEDICAL CLINIC
Practice address
605 W Hwy 82
Wallowa, OR 97885-7114
Phone
(541) 426-4502
NPI assigned
Jan 11, 2023
Last updated
Sep 13, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WINDING WATERS MEDICAL CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Keli Jean Dennis
Title
Authorized Official
Phone
(541) 426-4502

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

605 W Hwy 82
Wallowa, OR 97885-7114

Mailing address

603 Medical Pkwy
Enterprise, OR 97828-5124
Phone (541) 426-4502

Other names 1

  • Wallowa Pharmacy of Winding Waters Other name

National Provider Directory

National Provider Directory
Tax ID family
Winding Waters Medical Clin6 organizations share this tax ID, including this one
Part of
Winding Waters Medical Clin

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 W Main St
Enterprise, OR 97828
Phone (541) 426-0801

507 S River St
Enterprise, OR 97828
Phone (541) 263-1571

605 W Highway 82
Wallowa, OR 97885

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1114631322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 MEDICAL PKWY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 W HWY 82",
            "city": "WALLOWA",
            "state": "OR",
            "postal_code": "978857114",
            "telephone_number": "541-426-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINDING WATERS MEDICAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINDING WATERS MEDICAL CLINIC",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "KELI",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "541-426-4502"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallowa Pharmacy of Winding Waters",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Wallowa Pharmacy of Winding Waters",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wallowa, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.