| Umpqua Community Health Center, Inc. | |
|
20170 North Umpqua Highway Glide OR 97443 | |
| (541) 496-3504 | |
| (541) 464-3519 |
| Full Name | Umpqua Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 20170 North Umpqua Highway, Glide, Oregon |
| Authorized Official Name and Position | Kc Bolton (CEO) |
| Authorized Official Contact | 5416729596 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Umpqua Community Health Center, Inc. 150 Kenneth Ford Drive Roseburg OR 97470-1042 Ph: (541) 672-9596 | Umpqua Community Health Center, Inc. 20170 North Umpqua Highway Glide OR 97443 Ph: (541) 496-3504 |
| NPI Number | 1609065010 |
|---|---|
| Provider Enumeration Date | 10/22/2007 |
| Last Update Date | 06/28/2022 |
| Certification Date | 06/28/2022 |
| Medicare PECOS PAC ID | 0345233078 |
|---|---|
| Medicare Enrollment ID | O20040407000576 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609065010 | NPI | - | NPPES |
| 168395 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Oregon) | Primary |