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38505 Brooten Rd. Suite A Pacific City OR 97135 | |
(503) 965-6555 | |
(503) 965-6800 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 38505 Brooten Rd., Pacific City, Oregon |
Authorized Official Name and Position | M Sydney Thompson (PRACTICE ADMINISTRATOR) |
Authorized Official Contact | 5039656555 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 655 Pacific City OR 97135-0655 Ph: (503) 965-6555 | 38505 Brooten Rd. Suite A Pacific City OR 97135 Ph: (503) 965-6555 |
NPI Number | 1871591016 |
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Provider Enumeration Date | 07/12/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1871591016 | NPI | - | NPPES |
129788 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 383828 (Oregon) | Primary |