Club Northwest | |
2160 Nw Vine St Grants Pass OR 97526-8439 | |
(541) 955-2582 | |
Not Available |
Full Name | Club Northwest |
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Speciality | Clinic/center - Multi-specialty |
Location | 2160 Nw Vine St, Grants Pass, Oregon |
Authorized Official Name and Position | Stacy Rae Cappadona (REGISTERED DIETITIAN) |
Authorized Official Contact | 5419552582 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Club Northwest 2160 Nw Vine St Grants Pass OR 97526-8439 Ph: () - | Club Northwest 2160 Nw Vine St Grants Pass OR 97526-8439 Ph: (541) 955-2582 |
NPI Number | 1356854830 |
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Provider Enumeration Date | 11/07/2017 |
Last Update Date | 11/07/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356854830 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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