| Leslie Scott | |
|
44882 Mission Rd Pendleton OR 97801-9293 | |
| (541) 429-0550 | |
| (541) 276-3093 |
| Full Name | Leslie Scott |
|---|---|
| Speciality | Clinic/Center |
| Location | 44882 Mission Rd, Pendleton, Oregon |
| Authorized Official Name and Position | Leslie Neal Scott (OWNER) |
| Authorized Official Contact | 5414290550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leslie Scott 44882 Mission Rd Pendleton OR 97801-9293 Ph: (541) 429-0550 | Leslie Scott 44882 Mission Rd Pendleton OR 97801-9293 Ph: (541) 429-0550 |
| NPI Number | 1295369841 |
|---|---|
| Provider Enumeration Date | 02/22/2020 |
| Last Update Date | 10/13/2020 |
| Certification Date | 10/13/2020 |
| Medicare PECOS PAC ID | 1759791684 |
|---|---|
| Medicare Enrollment ID | O20201104003142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295369841 | NPI | - | NPPES |
| 500767575 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Leslie Neal Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902450042 PECOS PAC ID: 8426479502 Enrollment ID: I20200527001987 |
| Provider Name | Trevor Scott Rachko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598316572 PECOS PAC ID: 5991197196 Enrollment ID: I20220120001918 |
| Provider Name | David Eric Denton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104416353 PECOS PAC ID: 3375919566 Enrollment ID: I20221012003301 |
| Provider Name | Joshua Kenji Raoul Hellstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235994401 PECOS PAC ID: 7416395470 Enrollment ID: I20240410000282 |
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