Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 220 N. Main St., Irrigon, Oregon |
Authorized Official Name and Position | Nicole Mahoney (CFO) |
Authorized Official Contact | 5419225880 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 9 Heppner OR 97836-0009 Ph: (541) 922-5880 | 220 N. Main St. Irrigon OR 97844 Ph: (541) 922-5880 |
NPI Number | 1952331282 |
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Provider Enumeration Date | 07/03/2006 |
Last Update Date | 05/24/2016 |
Medicare PECOS PAC ID | 2365359296 |
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Medicare Enrollment ID | O20050712000528 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952331282 | NPI | - | NPPES |
168735 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 141444 (Oregon) | Primary |