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350 Mississippi Dr Gilchrist OR 97737-3243 | |
(541) 536-3435 | |
(541) 536-3332 |
Full Name | |
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Speciality | Clinic/Center |
Location | 350 Mississippi Dr, Gilchrist, Oregon |
Authorized Official Name and Position | Erin Trapp (CEO) |
Authorized Official Contact | 5418761837 |
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 3300 La Pine OR 97739-3300 Ph: (541) 536-3435 | 350 Mississippi Dr Gilchrist OR 97737-3243 Ph: (541) 536-3435 |
NPI Number | 1669889341 |
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Provider Enumeration Date | 07/15/2014 |
Last Update Date | 02/23/2023 |
Medicare PECOS PAC ID | 8224187018 |
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Medicare Enrollment ID | O20140812000273 |
Identifier | Type | State | Issuer |
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1669889341 | NPI | - | NPPES |
38-1953 | Other | OR | CMS CERTIFICATION NUMBER |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |