| Optimal Health Of Southern Oregon, Llc | |
|
1600 Nw 6th St South Suite Grants Pass OR 97526 | |
| (541) 507-1948 | |
| (541) 727-0382 |
| Full Name | Optimal Health Of Southern Oregon, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1600 Nw 6th St South Suite, Grants Pass, Oregon |
| Authorized Official Name and Position | Wendell Charles Heidinger (OWNER) |
| Authorized Official Contact | 5415071948 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Health Of Southern Oregon, Llc 1600 Nw 6th St South Suite Grants Pass OR 97526 Ph: (541) 507-1948 | Optimal Health Of Southern Oregon, Llc 1600 Nw 6th St South Suite Grants Pass OR 97526 Ph: (541) 507-1948 |
| NPI Number | 1902353907 |
|---|---|
| Provider Enumeration Date | 09/07/2016 |
| Last Update Date | 04/18/2018 |
| Medicare PECOS PAC ID | 7416238241 |
|---|---|
| Medicare Enrollment ID | O20170110000467 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902353907 | NPI | - | NPPES |
| 190932 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD18680 (Oregon) | Primary |
| Provider Name | Wendell C Heidinger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326184607 PECOS PAC ID: 1557424546 Enrollment ID: I20090119000025 |
| Provider Name | Kristi Ibarra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316304652 PECOS PAC ID: 5597057422 Enrollment ID: I20160713000520 |
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James Lee Calvert M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 181 Nw Bunnell Ave, Grants Pass, OR 97526 Phone: 541-479-4111 Fax: 541-955-1621 | |
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Kurt A Brewster Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1601 Ne 6th Street, Grants Pass, OR 97526 Phone: 541-474-1020 Fax: 541-474-1108 | |
Mountainview Family Practice Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 741 Ne 6th St, Grants Pass, OR 97526 Phone: 541-471-2701 Fax: 541-471-1166 | |
Brian Hancock Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 841 Ne 7th St, Grants Pass, OR 97526 Phone: 541-474-2721 Fax: 541-474-0056 | |
Karen Joyce Hoskins Msn/fnp Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1100 Ne 7th St Ste C, Grants Pass, OR 97526 Phone: 541-476-7000 Fax: 541-476-7000 |