Provider Demographics
NPI:1548999667
Name:KLAMATH HEALTH PARTNERSHIP INC
Entity type:Organization
Organization Name:KLAMATH HEALTH PARTNERSHIP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RO
Authorized Official - Prefix:
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-880-2011
Mailing Address - Street 1:2074 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-3372
Mailing Address - Country:US
Mailing Address - Phone:541-851-8110
Mailing Address - Fax:
Practice Address - Street 1:403 PINE ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6020
Practice Address - Country:US
Practice Address - Phone:541-851-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLAMATH HEALTH PARTNERSHIP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR101150OtherMEDICARE-B
OR170061Medicaid