Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 712 Jay St, Fossil, Oregon |
Authorized Official Name and Position | Teresa Gwendolyn Hunt (CFO) |
Authorized Official Contact | 5417632725 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 307 Fossil OR 97830-0307 Ph: (541) 763-2725 | 712 Jay St Fossil OR 97830-8371 Ph: (541) 763-2725 |
NPI Number | 1033989439 |
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Provider Enumeration Date | 01/05/2024 |
Last Update Date | 11/22/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033989439 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |