| Emerald Valley Wellness Clinic | |
|
300 N Mill St Ste A Creswell OR 97426-9848 | |
| (541) 895-5300 | |
| Not Available |
| Full Name | Emerald Valley Wellness Clinic |
|---|---|
| Speciality | General Practice |
| Location | 300 N Mill St Ste A, Creswell, Oregon |
| Authorized Official Name and Position | Richard A. Hansen (PRESIDENT) |
| Authorized Official Contact | 5418955300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emerald Valley Wellness Clinic Po Box 1057 Creswell OR 97426-1057 Ph: (541) 895-5300 | Emerald Valley Wellness Clinic 300 N Mill St Ste A Creswell OR 97426-9848 Ph: (541) 895-5300 |
| NPI Number | 1184833139 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 05/02/2012 |
| Medicare PECOS PAC ID | 1153315312 |
|---|---|
| Medicare Enrollment ID | O20040412000430 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184833139 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | MD22235 (Oregon) | Primary |
| Provider Name | Richard A Hansen |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1730275488 PECOS PAC ID: 0840284006 Enrollment ID: I20111219000815 |
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