Jan Radzik, Md | |
349 Se Baker St Mcminnville OR 97128-6039 | |
(503) 472-9438 | |
(503) 472-9439 |
Full Name | Jan Radzik, Md |
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Speciality | Clinic/Center |
Location | 349 Se Baker St, Mcminnville, Oregon |
Authorized Official Name and Position | Jan None Radzik (PRESIDENT) |
Authorized Official Contact | 5034729438 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jan Radzik, Md 349 Se Baker St Mcminnville OR 97128-6039 Ph: (503) 472-9438 | Jan Radzik, Md 349 Se Baker St Mcminnville OR 97128-6039 Ph: (503) 472-9438 |
NPI Number | 1295037968 |
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Provider Enumeration Date | 12/01/2010 |
Last Update Date | 12/01/2010 |
Medicare PECOS PAC ID | 2668669888 |
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Medicare Enrollment ID | O20101214000164 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295037968 | NPI | - | NPPES |
029186 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | MD17050 (Oregon) | Primary |
Provider Name | Jan Radzik |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1053467357 PECOS PAC ID: 9739376963 Enrollment ID: I20101214000213 |
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