| Elkhorn Family Medicine Pc | |
|
3705 Midway Dr Baker City OR 97814-1456 | |
| (541) 519-4204 | |
| Not Available |
| Full Name | Elkhorn Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3705 Midway Dr, Baker City, Oregon |
| Authorized Official Name and Position | Logan Frederickson (OWNER) |
| Authorized Official Contact | 5415194250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elkhorn Family Medicine Pc 3705 Midway Dr Baker City OR 97814-1456 Ph: (541) 519-4204 | Elkhorn Family Medicine Pc 3705 Midway Dr Baker City OR 97814-1456 Ph: (541) 519-4204 |
| NPI Number | 1881263721 |
|---|---|
| Provider Enumeration Date | 06/24/2021 |
| Last Update Date | 02/01/2024 |
| Medicare PECOS PAC ID | 5395134118 |
|---|---|
| Medicare Enrollment ID | O20211117002044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881263721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Logan C Frederickson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609215573 PECOS PAC ID: 2860782828 Enrollment ID: I20160706000891 |
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