Umpqua Community Health Center, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

UMPQUA COMMUNITY HEALTH CENTER, INC.

Practice address

3031 NE Stephens St Ste 900
Roseburg, OR 97470-6237

Phone

(541) 672-9596

Fax

(541) 492-2060

NPI assigned

May 25, 2021

Last updated

Jun 28, 2022By the provider in NPPES

Organization subpart

No

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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1396751772

  O20040511000463

  Same enrollment
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Myrtle Creek, OR
  • NPI 1508018946

  O20040511000463

  Same enrollment
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1588231021

  O20040511000463

  Same enrollment
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Glide, OR
  • NPI 1609065010

  O20040511000463

  Same enrollment
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sutherlin, OR
  • NPI 1619399888

  O20040511000463

  Same enrollment
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Drain, OR
  • NPI 1649469909

  O20040511000463

  Same enrollment
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1891427811

  O20040511000463

  Same enrollment

Locations

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1548835150",
    "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": "3031 NE STEPHENS ST STE 900",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974706237",
            "telephone_number": "541-672-9596",
            "fax_number": "541-492-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UMPQUA COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Umpqua Community Health Center, Inc.
• Umpqua Community Health Center, Inc. (Aviva Health)

• Federally Qualified Health Center (FQHC) in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Federally Qualified Health Center (FQHC) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.