Provider Demographics
NPI:1780607739
Name:KLAMATH COUNTY
Entity type:Organization
Organization Name:KLAMATH COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-885-2434
Mailing Address - Street 1:3314 VANDENBERG RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-3730
Mailing Address - Country:US
Mailing Address - Phone:541-882-8846
Mailing Address - Fax:541-885-3638
Practice Address - Street 1:3314 VANDENBERG RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3730
Practice Address - Country:US
Practice Address - Phone:541-882-8846
Practice Address - Fax:541-885-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR043054251K00000X
OR320051251K00000X
OR000075251K00000X
261QA0005X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR320051Medicaid
OR000075Medicaid
OR043054Medicaid
OR320051Medicaid
OR320051Medicaid