Provider Demographics
NPI:1306511183
Name:SOUTH WASCO COMMUNITY HEALTH
Entity type:Organization
Organization Name:SOUTH WASCO COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAPLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-993-4650
Mailing Address - Street 1:142 S LOUISA RD
Mailing Address - Street 2:
Mailing Address - City:TYGH VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97063-9742
Mailing Address - Country:US
Mailing Address - Phone:541-993-4650
Mailing Address - Fax:
Practice Address - Street 1:505 DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:MAUPIN
Practice Address - State:OR
Practice Address - Zip Code:97037-7002
Practice Address - Country:US
Practice Address - Phone:541-993-4650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty