| North Lake Clinic | |
|
87520 Bay Rd Pob 377 Christmas Valley OR 97641-0377 | |
| (541) 576-2343 | |
| (541) 576-2869 |
| Full Name | North Lake Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 87520 Bay Rd, Christmas Valley, Oregon |
| Authorized Official Name and Position | Patricia D Widenoja (OWNER) |
| Authorized Official Contact | 5415762343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Lake Clinic Pob377 87520 Bay Rd Christmas Valley OR 97641 Ph: (541) 576-2343 | North Lake Clinic 87520 Bay Rd Pob 377 Christmas Valley OR 97641-0377 Ph: (541) 576-2343 |
| NPI Number | 1457745101 |
|---|---|
| Provider Enumeration Date | 03/20/2015 |
| Last Update Date | 03/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457745101 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 078041667 (Oregon) | Primary |
North Lake Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 87520 Bay Rd, Christmas Valley, OR 97641 Phone: 541-576-2343 Fax: 541-576-2869 | |
Bruce D Carlson M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 87480 Spruce Ln, Christmas Valley, OR 97641 Phone: 541-576-2343 Fax: 541-576-2869 |