| Fifth Corner Community Services | |
|
1900 Ne Highway 99w Ste K Mcminnville OR 97128-2757 | |
| (503) 472-4511 | |
| (503) 714-6306 |
| Full Name | Fifth Corner Community Services |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 1900 Ne Highway 99w Ste K, Mcminnville, Oregon |
| Authorized Official Name and Position | Roxanne Franklin Wilson (PRESIDENT/PROGRAM ADMINISTRATOR) |
| Authorized Official Contact | 5037146306 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fifth Corner Community Services 650 Ne 2nd St Unit 133 Mcminnville OR 97128-4762 Ph: (503) 472-4511 | Fifth Corner Community Services 1900 Ne Highway 99w Ste K Mcminnville OR 97128-2757 Ph: (503) 472-4511 |
| NPI Number | 1033753231 |
|---|---|
| Provider Enumeration Date | 10/30/2019 |
| Last Update Date | 03/28/2020 |
| Certification Date | 03/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033753231 | NPI | - | NPPES |
| 1851475099 | Medicaid | OR |
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