Look up the most recent NPI and PECOS records

Grande Ronde Hospital Inc

(Grande Ronde Hospital Medical Clinic)

Family Medicine

Allopathic & Osteopathic Physicians

700 Sunset Dr Ste G, La Grande, OR 97850-1260

PECOS Enrollment

Based on the most recent information from CMS, provider Grande Ronde Hospital Inc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1083895767
Provider Type
Organization
Full Name
Grande Ronde Hospital Inc
Other Name
Grande Ronde Hospital Medical Clinic

Subpart
No
Enumeration Date
11/21/2007
Last Updated
11/21/2007

Contact Information

Practice Location

700 Sunset Dr Ste G, La Grande, OR 97850-1260

(541) 963-6070

(541) 963-6490

Mailing Location

700 Sunset Dr Ste G, La Grande, OR 97850-1260

(541) 963-6070

(541) 963-6490

Authorized Official

Mattes, James (President)

(541) 963-1469

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 394792 Oregon

Grande Ronde Hospital Inc

(Grande Ronde Hospital Medical Clinic)

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Kim R. Montee, M.D., P.C.

Conklin, Bryan Richard

Yangson, Anda Karleen Balderrama

Tishman, Bradley Jack

Michael H. Mcqueen M.D P.C

Schoenfelder, Ellen K

Porter, Mary Grace

Bryan R Conklin Md Pc

Hansen, Mckenzie

Tishman, Naghmeh