| Hearthside Medicine Family Care | |
|
205 Nw Franklin Ave Bend OR 97703-2801 | |
| (541) 316-5693 | |
| (541) 255-0947 |
| Full Name | Hearthside Medicine Family Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 205 Nw Franklin Ave, Bend, Oregon |
| Authorized Official Name and Position | Havilah Noel Brodhead (CO-OWNER) |
| Authorized Official Contact | 9702756108 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hearthside Medicine Family Care 2947 Ne Yellow Ribbon Dr Bend OR 97701-7657 Ph: (970) 275-6108 | Hearthside Medicine Family Care 205 Nw Franklin Ave Bend OR 97703-2801 Ph: (541) 316-5693 |
| NPI Number | 1477051795 |
|---|---|
| Provider Enumeration Date | 02/01/2018 |
| Last Update Date | 11/13/2018 |
| Medicare PECOS PAC ID | 5597095620 |
|---|---|
| Medicare Enrollment ID | O20191002002684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477051795 | NPI | - | NPPES |
| 500678393 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 201407546NP-PP (Oregon) | Primary |
| Provider Name | Jeremy L Brodhead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801272513 PECOS PAC ID: 3072814177 Enrollment ID: I20151215000747 |
| Provider Name | Havilah Noel Brodhead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841584844 PECOS PAC ID: 6305169442 Enrollment ID: I20191002002827 |
| Provider Name | Marie Elise Mency |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932567880 PECOS PAC ID: 0648511832 Enrollment ID: I20210428001053 |
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