| North Bend Otp | |
|
400 Virginia Ave Ste 100 North Bend OR 97459-3477 | |
| (541) 672-2691 | |
| Not Available |
| Full Name | North Bend Otp |
|---|---|
| Speciality | Counselor |
| Location | 400 Virginia Ave Ste 100, North Bend, Oregon |
| Authorized Official Name and Position | Debbie L Phillips (DIRECTOR OF CLIENT SERVICES) |
| Authorized Official Contact | 5414924550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Bend Otp Po Box 1121 Roseburg OR 97470-0254 Ph: () - | North Bend Otp 400 Virginia Ave Ste 100 North Bend OR 97459-3477 Ph: (541) 672-2691 |
| NPI Number | 1497248025 |
|---|---|
| Provider Enumeration Date | 06/08/2018 |
| Last Update Date | 06/08/2018 |
| Medicare PECOS PAC ID | 4587662887 |
|---|---|
| Medicare Enrollment ID | O20200416000805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497248025 | NPI | - | NPPES |
| 218156 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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