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621 W Madrone St Roseburg OR 97470-3090 | |
| (541) 440-3532 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 621 W Madrone St, Roseburg, Oregon |
| Authorized Official Name and Position | Peggy E Madison (HEALTH DEPARTMENT ADMINISTRATOR) |
| Authorized Official Contact | 5414403625 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
621 W Madrone St Roseburg OR 97470-3090 Ph: (541) 440-3532 | 621 W Madrone St Roseburg OR 97470-3090 Ph: (541) 440-3532 |
| NPI Number | 1023165792 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 05/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023165792 | NPI | - | NPPES |
| 500602529 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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