| Madras Medical Group P.c. | |
|
76 Ne 12th St Madras OR 97741-1827 | |
| (541) 475-3874 | |
| (541) 475-3503 |
| Full Name | Madras Medical Group P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 76 Ne 12th St, Madras, Oregon |
| Authorized Official Name and Position | David V Evans (VICE PRESIDENT) |
| Authorized Official Contact | 5414753874 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madras Medical Group P.c. 76 Ne 12th St Madras OR 97741-1827 Ph: (541) 475-3874 | Madras Medical Group P.c. 76 Ne 12th St Madras OR 97741-1827 Ph: (541) 475-3874 |
| NPI Number | 1093768533 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 05/20/2009 |
| Medicare PECOS PAC ID | 5597758102 |
|---|---|
| Medicare Enrollment ID | O20040407001171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093768533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gary M Plant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417900317 PECOS PAC ID: 6406830785 Enrollment ID: I20040615000738 |
| Provider Name | Kristine M Delamarter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902018757 PECOS PAC ID: 8527152115 Enrollment ID: I20071029000063 |
| Provider Name | Thomas M Manning |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518964600 PECOS PAC ID: 8820016041 Enrollment ID: I20101119000224 |
| Provider Name | Nicholas Zoltan Blake |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811300999 PECOS PAC ID: 2163797473 Enrollment ID: I20171011003065 |
| Provider Name | Taouea Juanita Vitousek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760768030 PECOS PAC ID: 9739434770 Enrollment ID: I20180615001721 |
| Provider Name | Joanne Patricia Boisvert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407242969 PECOS PAC ID: 7719216449 Enrollment ID: I20190905002867 |
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