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110 N Court St Heppner OR 97836-7328 | |
(541) 676-5421 | |
(541) 676-5652 |
Full Name | |
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Speciality | Clinic/Center |
Location | 110 N Court St, Heppner, Oregon |
Authorized Official Name and Position | Robin Canaday (PUBLIC HEALTH DIRECTOR) |
Authorized Official Contact | 5416765421 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 799 Heppner OR 97836-0799 Ph: (541) 676-5421 | 110 N Court St Heppner OR 97836-7328 Ph: (541) 676-5421 |
NPI Number | 1952302689 |
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Provider Enumeration Date | 08/03/2005 |
Last Update Date | 07/18/2024 |
Medicare PECOS PAC ID | 3072416437 |
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Medicare Enrollment ID | O20040202000124 |
Identifier | Type | State | Issuer |
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1952302689 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Primary |
Provider Name | Emily J Jack |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1275197691 PECOS PAC ID: 6507193042 Enrollment ID: I20221115002877 |