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1813 W Harvard Ave Ste 241 Roseburg OR 97471-8708 | |
(541) 671-5342 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 1813 W Harvard Ave Ste 241, Roseburg, Oregon |
Authorized Official Name and Position | Joshua Fisher (PRESIDENT) |
Authorized Official Contact | 5416715342 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1813 W Harvard Ave Ste 241 Roseburg OR 97471-8708 Ph: (541) 671-5342 | 1813 W Harvard Ave Ste 241 Roseburg OR 97471-8708 Ph: (541) 671-5342 |
NPI Number | 1356181838 |
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Provider Enumeration Date | 05/30/2024 |
Last Update Date | 08/13/2024 |
Medicare PECOS PAC ID | 6608314844 |
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Medicare Enrollment ID | O20240819002520 |
Identifier | Type | State | Issuer |
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1356181838 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Joshua M Fisher |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508446170 PECOS PAC ID: 5890196455 Enrollment ID: I20230511002769 |
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