| Deschutes Family Care | |
|
1345 Nw Wall St Suite 302 Bend OR 97703-1972 | |
| (541) 323-3960 | |
| (541) 323-3961 |
| Full Name | Deschutes Family Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 1345 Nw Wall St, Bend, Oregon |
| Authorized Official Name and Position | Mark Edward Gonsky (OWNER) |
| Authorized Official Contact | 5413233960 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deschutes Family Care 1345 Nw Wall St Suite 302 Bend OR 97703-1972 Ph: (541) 323-3960 | Deschutes Family Care 1345 Nw Wall St Suite 302 Bend OR 97703-1972 Ph: (541) 323-3960 |
| NPI Number | 1740654086 |
|---|---|
| Provider Enumeration Date | 11/24/2015 |
| Last Update Date | 01/10/2024 |
| Medicare PECOS PAC ID | 5890097455 |
|---|---|
| Medicare Enrollment ID | O20160113002588 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740654086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | DO 155003 (Oregon) | Primary |
| Provider Name | Mark Gonsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841464203 PECOS PAC ID: 2466611629 Enrollment ID: I20120307000260 |
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