NPIMap

Organization Active NPI

Confederated Tribes of Grand Ronde Community of Oregon

  • Clinical Medical Laboratory
  • Grand Ronde, OR
National Provider Identifier
1326513367
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CONFEDERATED TRIBES OF GRAND RONDE COMMUNITY OF OREGON
Practice address
9615 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone
(503) 879-2060
Fax
(503) 879-5089
NPI assigned
Oct 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2018

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

Authorized official

Name
Dana Morfin
Title
Quality Analyst
Phone
(503) 879-2060

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

9615 Grand Ronde Rd
Grand Ronde, OR 97347-9712

Mailing address

9615 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone (503) 879-2060

Other identifiers 1

IdentifierTypeStateIssuer
126883MedicaidOR

Other names 1

  • Grand Ronde Health & Wellness Center Lab Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2329238Grand Ronde Public Health9615 Grand Ronde Rd BLD A1, Grand Ronde, OR 97347Certificate of waiverAug 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Confederated Tribes of Grand Ronde Community of Oregon Dba GR Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1326513367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9615 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2060",
            "fax_number": "503-879-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9615 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2060",
            "fax_number": "503-879-5089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONFEDERATED TRIBES OF GRAND RONDE COMMUNITY OF OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-10-05",
        "status": "A",
        "authorized_official_last_name": "MORFIN",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "QUALITY ANALYST",
        "authorized_official_telephone_number": "503-879-2060"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126883",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Ronde Health & Wellness Center Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Ronde, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.