| North Lake Clinic, Llc | |
|
87520 Bay Rd Christmas Valley OR 97641-0377 | |
| (541) 576-2343 | |
| (541) 576-2869 |
| Full Name | North Lake Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 87520 Bay Rd, Christmas Valley, Oregon |
| Authorized Official Name and Position | Bruce D Carlson (OWNER) |
| Authorized Official Contact | 5415762343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Lake Clinic, Llc Po Box 377 Christmas Valley OR 97641-0377 Ph: (541) 576-2343 | North Lake Clinic, Llc 87520 Bay Rd Christmas Valley OR 97641-0377 Ph: (541) 576-2343 |
| NPI Number | 1669607792 |
|---|---|
| Provider Enumeration Date | 05/19/2009 |
| Last Update Date | 05/19/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669607792 | NPI | - | NPPES |
| 080385000 | Other | BCBS OF OREGON | |
| 182817 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | MD07786 (Oregon) | Primary |
North Lake Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 87520 Bay Rd, Pob 377, 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 |