| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 621 W Madrone St, Roseburg, Oregon |
| Authorized Official Name and Position | Debbie L Phillips (DIRECTOR OF BILLING SERVICES) |
| Authorized Official Contact | 5414920134 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1121 Roseburg OR 97470-0254 Ph: () - | 621 W Madrone St Roseburg OR 97470 Ph: (541) 492-0241 |
| NPI Number | 1639682883 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 12/23/2020 |
| Certification Date | 08/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639682883 | NPI | - | NPPES |
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