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100 Mullins Dr Ste A1 Lebanon OR 97355-2868 | |
(541) 451-6920 | |
(541) 451-6924 |
Full Name | |
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Speciality | Clinic/Center |
Location | 100 Mullins Dr Ste A1, Lebanon, Oregon |
Authorized Official Name and Position | Sherlyn Dahl (HEALTH CENTER DIRECTOR) |
Authorized Official Contact | 5417662131 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 579 Corvallis OR 97339-0579 Ph: (541) 766-6835 | 100 Mullins Dr Ste A1 Lebanon OR 97355-2868 Ph: (541) 451-6920 |
NPI Number | 1093997710 |
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Provider Enumeration Date | 12/04/2007 |
Last Update Date | 12/18/2024 |
Medicare PECOS PAC ID | 6709858020 |
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Medicare Enrollment ID | O20080731000720 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093997710 | NPI | - | NPPES |
03932800 | Other | REGENCE BCBS | |
700228501 | Other | REGENCE BCBS | |
227701 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |