Full Name | |
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Speciality | Clinic/Center |
Location | 325 Park St, Lebanon, Oregon |
Authorized Official Name and Position | Marty Cahill (CEO) |
Authorized Official Contact | 5414517914 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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325 Park St Lebanon OR 97355-4229 Ph: (541) 451-7200 | 325 Park St Lebanon OR 97355-4229 Ph: (541) 451-7200 |
NPI Number | 1427315662 |
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Provider Enumeration Date | 04/12/2012 |
Last Update Date | 11/05/2018 |
Medicare PECOS PAC ID | 2769391523 |
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Medicare Enrollment ID | O20180419002734 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427315662 | NPI | - | NPPES |
500651505 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |