NPIMap

Organization Active NPI

Mid-Columbia Medical Center

Doing business as Adventist Health Columbia Gorge

  • Rural Health Clinic/Center
  • The Dalles, OR
National Provider Identifier
1871833772
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
383895 Issued in OR
Legal business name
MID-COLUMBIA MEDICAL CENTER
Doing business as
Adventist Health Columbia Gorge
Columbia River Women's Center
Practice address
1810 E 19TH St Ste 209
The Dalles, OR 97058-3388
Phone
(541) 296-5657
Fax
(541) 298-5199
NPI assigned
Mar 1, 2013
Last updated
Apr 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

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

Authorized official

Name
Kyle King
Title
Service Area President
Phone
(503) 261-4405

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 383895 OR Primary
Obstetrics & Gynecology Physician 207V00000X OR

Addresses

Primary practice location

1810 E 19TH St Ste 209
The Dalles, OR 97058-3388

Mailing address

PO Box 1520
1810 E. 19TH St. Ste.209
The Dalles, OR 97058-3388
Phone (541) 296-5657

Other identifiers 2

IdentifierTypeStateIssuer
2028140MedicaidWA
500654923MedicaidOR

Other names 2

  • Adventist Health Columbia Gorge Doing business as
  • Columbia River Women's Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031209000244 OR Part B Supplier - Clinic/Group Practice 3779487251 Receives reassigned benefits from 219 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hood River, OR; The Dalles, OR
O20170214001716 OR Part A Provider - Rural Health Clinic 3779487251 Practice locations: The Dalles, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871833772. Details of each certification follow.

Rural health clinic certification: CCN 383895

Legal name
MID-COLUMBIA MEDICAL CENTER
Doing business as
COLUMBIA RIVER WOMEN'S CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 11, 2017
Last certification
Jul 12, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 20, 1984 in OR
Enrollment address
1810 E 19TH St
Ste 209
The Dalles, OR 97058-3388

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

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
38D0703300Columbia River Women's Center1810 E 19TH St Suite 209, The Dalles, OR 97058Provider-performed microscopyDec 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
The Dalles Family Pract6 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Micah P Smith Individual Corporate OfficerFinance Officer Feb 28, 2025
W-2 Managing Employee Feb 28, 2025
Kyle a King Individual Corporate Director Apr 24, 2024
W-2 Managing Employee Apr 24, 2024
Kerry L Heinrich Individual Corporate Officer Jun 1, 2023
Meredith S Jobe Individual Corporate Officer Jun 1, 2023
Eric a Stevens Individual Corporate Officer Mar 5, 2025
W-2 Managing Employee Mar 5, 2025
Richard K Reiner Individual Corporate Director Jun 1, 2023
Stone Point Health Organization, Roseville, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2023
Larry L Innocent Individual Corporate Director Jun 1, 2023

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744588800000",
    "number": "1871833772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1520",
            "address_2": "1810 E. 19TH ST. STE.209",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583388",
            "telephone_number": "541-296-5657",
            "fax_number": "541-298-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 E 19TH ST STE 209",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583388",
            "telephone_number": "541-296-5657",
            "fax_number": "541-298-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-COLUMBIA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-01",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "SERVICE AREA PRESIDENT",
        "authorized_official_telephone_number": "503-261-4405"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OR",
            "license": "383895",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2028140",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500654923",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adventist Health Columbia Gorge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbia River Women's Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbia River Women's Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Dalles, OR

Sources for this page

Verify at the official NPI Registry.