Earth Song Medical Practice Llc | |
18173 Redwood Hwy Selma OR 97538 | |
(541) 237-4470 | |
Not Available |
Full Name | Earth Song Medical Practice Llc |
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Speciality | Clinic/Center |
Location | 18173 Redwood Hwy, Selma, Oregon |
Authorized Official Name and Position | Michael G Pruner (OWNER/MANAGER) |
Authorized Official Contact | 5412374470 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Earth Song Medical Practice Llc 4567 Deer Creek Rd Selma OR 97538-9612 Ph: (541) 237-4470 | Earth Song Medical Practice Llc 18173 Redwood Hwy Selma OR 97538 Ph: (541) 237-4470 |
NPI Number | 1912462144 |
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Provider Enumeration Date | 02/01/2019 |
Last Update Date | 02/01/2019 |
Medicare PECOS PAC ID | 8628310273 |
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Medicare Enrollment ID | O20190430002173 |
Identifier | Type | State | Issuer |
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1912462144 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Michael G Pruner |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356472161 PECOS PAC ID: 4789772542 Enrollment ID: I20141119002511 |
Provider Name | Linda Marie Almeida |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1831110428 PECOS PAC ID: 5092066498 Enrollment ID: I20180925000824 |