NPIMap

Organization Active NPI

Umpqua Community Health Center, Inc.

Doing business as Myrtle Creek Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Myrtle Creek, OR
National Provider Identifier
1366168080
Registry record updated Oct 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UMPQUA COMMUNITY HEALTH CENTER, INC.
Doing business as
Myrtle Creek Dental Clinic
Practice address
244 NE Division St
Myrtle Creek, OR 97457-8507
Phone
(541) 672-9596
Fax
(541) 492-2060
NPI assigned
Oct 14, 2022
Last updated
Oct 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2022

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

Authorized official

Name
KC Bolton
Title
Ceo
Phone
(541) 672-9596

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Dentist 122300000X NU

Addresses

Primary practice location

244 NE Division St
Myrtle Creek, OR 97457-8507

Mailing address

150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042
Phone (541) 672-9596

Other names 1

  • Myrtle Creek Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Open Door Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

150 NE Kenneth Ford Dr
Roseburg, OR 97470

NPI Registry JSON

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

{
    "created_epoch": "1665705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1366168080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 NE KENNETH FORD DR",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701042",
            "telephone_number": "541-672-9596",
            "fax_number": "541-492-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 NE DIVISION ST",
            "city": "MYRTLE CREEK",
            "state": "OR",
            "postal_code": "974578507",
            "telephone_number": "541-672-9596",
            "fax_number": "541-492-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UMPQUA COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-14",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "KC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-672-9596"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Myrtle Creek Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Myrtle Creek, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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.