| Peak Experience, Pc | |
|
149 Clear Creek Dr Suite 102 Ashland OR 97520-1881 | |
| (541) 951-4329 | |
| Not Available |
| Full Name | Peak Experience, Pc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 149 Clear Creek Dr, Ashland, Oregon |
| Authorized Official Name and Position | Scott Bandoroff (PRESIDENT) |
| Authorized Official Contact | 5419514329 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peak Experience, Pc 552 Beach St Ashland OR 97520-3212 Ph: (541) 951-4329 | Peak Experience, Pc 149 Clear Creek Dr Suite 102 Ashland OR 97520-1881 Ph: (541) 951-4329 |
| NPI Number | 1154794832 |
|---|---|
| Provider Enumeration Date | 11/04/2015 |
| Last Update Date | 11/04/2015 |
| Medicare PECOS PAC ID | 7416253885 |
|---|---|
| Medicare Enrollment ID | O20160310001382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154794832 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1120 (Oregon) | Primary |
| Provider Name | Scott A Bandoroff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801096334 PECOS PAC ID: 9032257605 Enrollment ID: I20091119000248 |
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