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1050 W Elm Ave Suite #110 Hermiston OR 97838-2700 | |
| (541) 567-3797 | |
| (541) 567-7720 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1050 W Elm Ave, Hermiston, Oregon |
| Authorized Official Name and Position | Jonathan Edwards (FINANCE DIRECTOR) |
| Authorized Official Contact | 5416673438 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
610 Nw 11th St Hermiston OR 97838-6601 Ph: (541) 667-3438 | 1050 W Elm Ave Suite #110 Hermiston OR 97838-2700 Ph: (541) 567-3797 |
| NPI Number | 1174604839 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 12/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174604839 | NPI | - | NPPES |
| 276278 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD09041 (Oregon) | Primary |
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