| Basic Family Healthcare Inc | |
|
1813 W Harvard Ave Ste 233 Roseburg OR 97471-8704 | |
| (541) 241-3071 | |
| (541) 241-8031 |
| Full Name | Basic Family Healthcare Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1813 W Harvard Ave Ste 233, Roseburg, Oregon |
| Authorized Official Name and Position | Eileen Melody Cleveland (ADMINISTRATOR) |
| Authorized Official Contact | 5412413071 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Basic Family Healthcare Inc Po Box 345 Roseburg OR 97470-0059 Ph: (541) 241-3071 | Basic Family Healthcare Inc 1813 W Harvard Ave Ste 233 Roseburg OR 97471-8704 Ph: (541) 241-3071 |
| NPI Number | 1376917641 |
|---|---|
| Provider Enumeration Date | 11/24/2015 |
| Last Update Date | 06/02/2021 |
| Medicare PECOS PAC ID | 5698077626 |
|---|---|
| Medicare Enrollment ID | O20171108003038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376917641 | NPI | - | NPPES |
| 1700049152 | Other | ID | PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Eileen M Cleveland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700049152 PECOS PAC ID: 8921176652 Enrollment ID: I20171214001652 |
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