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387 Pinetop Terrace Shady Cove OR 97539 | |
| (541) 878-3537 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 387 Pinetop Terrace, Shady Cove, Oregon |
| Authorized Official Name and Position | Kelly Marie Clayton (PRESIDENT) |
| Authorized Official Contact | 5418783537 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1 Shady Cove OR 97539-0001 Ph: (541) 878-3537 | 387 Pinetop Terrace Shady Cove OR 97539 Ph: (541) 878-3537 |
| NPI Number | 1104089309 |
|---|---|
| Provider Enumeration Date | 07/08/2008 |
| Last Update Date | 07/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104089309 | NPI | - | NPPES |
| 1396744769 | Other | OR | INDIVIDUAL NPI |
| 228862 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 200150078NP (Oregon) | Primary |
Rogue Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 37 Schoolhouse Ln, Shady Cove, OR 97539 Phone: 541-878-1400 | |