Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 47815 Highway 58, Oakridge, Oregon |
Authorized Official Name and Position | Orion Falvey (PRESIDENT) |
Authorized Official Contact | 9073140100 |
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 546 Gresham OR 97030-0132 Ph: () - | 47815 Highway 58 Oakridge OR 97463 Ph: (541) 782-8304 |
NPI Number | 1588088983 |
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Provider Enumeration Date | 02/06/2014 |
Last Update Date | 10/01/2021 |
Medicare PECOS PAC ID | 3476786609 |
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Medicare Enrollment ID | O20140423002137 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588088983 | NPI | - | NPPES |
500676848 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Green Mountain Medical Clinic Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 48260 Hills St, Oakridge, OR 97463 Phone: 541-782-4201 Fax: 541-782-4203 |