NPIMap

Organization Active NPI

Mid-Columbia Medical Center

  • Multi-Specialty Clinic/Center
  • The Dalles, OR
National Provider Identifier
1992094817
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MID-COLUMBIA MEDICAL CENTER
Practice address
1825 E 19TH St
The Dalles, OR 97058-3365
Phone
(541) 506-6920
Fax
(541) 296-5451
NPI assigned
Mar 31, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Authorized official

Name
Dennis Knox
Title
Corporate Officer Ceo
Phone
(541) 296-7273

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

1825 E 19TH St
The Dalles, OR 97058-3365

Mailing address

PO Box 1520
The Dalles, OR 97058-8003
Phone (541) 506-6920

Other practice location 1

551 Lone Pine Blvd Ste 200
The Dalles, OR 97058-9404
Phone (541) 506-5866

Other identifiers 2

IdentifierTypeStateIssuer
2013509MedicaidWA
500636659MedicaidOR

Other names 3

  • Adventist Health Columbia Gorge Doing business as
  • MCMC Occupational Health Doing business as
  • MCMC Specialty Clinics Waters Edge Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

1815 E 19th St
Ste 2
The Dalles, OR 97058
Phone (541) 296-7526

1852 E 19TH St
The Dalles, OR 97058

1935 E 19th St
Ste 100
The Dalles, OR 97058
Phone (541) 296-7677

Practitioners & affiliated clinicians

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1992094817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1520",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970588003",
            "telephone_number": "541-506-6920",
            "fax_number": "541-296-5451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 E 19TH ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583365",
            "telephone_number": "541-506-6920",
            "fax_number": "541-296-5451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "551 Lone Pine Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "The Dalles",
            "state": "OR",
            "postal_code": "970589404",
            "country_code": "US",
            "telephone_number": "541-506-5866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MID-COLUMBIA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-31",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "KNOX",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CORPORATE OFFICER CEO",
        "authorized_official_telephone_number": "541-296-7273"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2013509",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500636659",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adventist Health Columbia Gorge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCMC Occupational Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCMC Specialty Clinics Waters Edge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Dalles, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.