NPIMap

Organization Active NPI

Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
National Provider Identifier
1700745783
Registry record updated Jan 16, 2026
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.
Practice address
1128 SE Stephens St
Roseburg, OR 97470-4820
Phone
(541) 672-9596
Fax
(541) 464-3519
NPI assigned
Jan 16, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2026

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

Authorized official

Name
KC Bolton
Title
Chief Executive Officer
Phone
(541) 672-9596

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1128 SE Stephens St
Roseburg, OR 97470-4820

Mailing address

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

Other names 1

  • Aviva Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Leslie L McCullough MD9 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

1128 SE Stephens St
Roseburg, OR 97470

NPI Registry JSON

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

{
    "created_epoch": "1768521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768521600000",
    "number": "1700745783",
    "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": "541-464-3519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 SE STEPHENS ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974704820",
            "telephone_number": "541-672-9596",
            "fax_number": "541-464-3519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UMPQUA COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-16",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "KC",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "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": [
        {
            "organization_name": "Aviva Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; 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.